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Background: Surgical treatment of C1/C2 subluxation has evolved significantly over the past 2 decades, from the relatively simpler posterior wiring to more technically demanding instrumentations such as C1 lateral mass screws - C2 pedicle screws, C1/C2 transarticular screws, and occipital cervical fusion. Navigation with fluoroscopy is currently the standard of practice in most centers. However, fluoroscopy at this level carries several major drawbacks, such as blockage by the mandible and inability to produce axial images for assessment of the reduction of rotatory subluxation.
Methods: The authors report a series of 21 patients with C1/C2 subluxation treated surgically with intraoperative computed tomography (ICT) guidance.
Results: There were 7 children and 14 adults. Eight patients underwent C1/C2 fixation with a Harm's construct, and 13 patients underwent occipital cervical fusion. One out of 17 (6%) C1 lateral mass screws has breached the medial wall of lateral mass by 1 mm. Two out of 20 (10%) C2 pedicle screws have breached the foramen transversarium by 1 mm (Neo classification grade 1). The position of all subaxial screws (49 lateral mass screws and 13 pedicle screws) and occipital screws (50 screws) appeared satisfactory. No neurovascular damage occurred in all the patients.
Conclusions: Ninety eight percent of the screws were placed in ideal position with the aid of ICT. Only 2% of the screws deviated from the planned position, but the breaches were not clinically significant and hence no revision was required. This showed that ICT guidance can help to achieve a high accuracy of surgical instrumentation for the treatment of C1/C2 subluxation.
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http://dx.doi.org/10.4103/2152-7806.109454 | DOI Listing |
Acta Sci Neurol
July 2024
Department of Psychiatry, Case Western Reserve University, School of Medicine, Cleveland, USA.
Unlabelled: This case study demonstrates that craniocervical spinal alignment with the EPIC technique spinal procedure appears to have a potential positive impact on ocular function. This paper will report the case of a patient with cranial nerve VI palsy and dizziness, and the clinical improvements following treatment with the soundwave technology of the EPIC technique spinal procedure [1].
Objective: To report the case of a patient with cranial nerve VI (CN VI) palsy and the clinical changes that occurred after receiving treatment using the EPIC (Evolutionary Percussion Instrument Corrections) technique spinal procedure.
World Neurosurg
November 2024
Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India. Electronic address:
Objective: To analyse patients with recurrent atlanto-axial dislocation and give a criterion of an ideal patient who can benefit from redo surgery.
Methods: This retrospective study was conducted in a tertiary care center, which included 20 patients who failed atlanto-axial surgery from January 2013 to June December 2021. They were evaluated using X-ray, computed tomography, and magnetic resonance imaging examinations, and their clinical data were accessed from the hospital's medical records department and the picture archiving and communication system.
World Neurosurg
November 2024
Department of Spinal Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland. Electronic address:
Asian J Neurosurg
September 2024
Department of Interventional Neuroradiology, Indo American Hospital, Institute of Brain and Spine, Vaikom, Kerala, India.
Bow Hunter's syndrome (BHS) is a very rare condition in which there is rotational vertebral artery (VA) insufficiency. The association of BHS with rotational atlantoaxial instability is extremely rare. We are reporting a case of pediatric BHS who presented with features of VA insufficiency on neck rotation.
View Article and Find Full Text PDFRinsho Shinkeigaku
September 2024
Department of Cerebrovascular medicine, Niigata City General Hospital.
A 55-year-old woman suffered from diplopia and occipital pain after shoveling snow. She was diagnosed with the right vertebral artery dissecting aneurysm at the level of the axial vertebra and repeatedly had cerebral infarctions in the posterior circulation. She had subluxation of the atlantoaxial vertebra as an underlying disease.
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