Perioperative complications associated with fluoroscopy C1 lateral mass screw fixation (Goel technique) versus computed tomography-guided navigation technique: A review of 202 cases from the German Spine Registry (DWG-Register).

Background: Overview of the literature - Fractures of the C1 constitute 3%-13% of all cervical spine injuries in adults. Most isolated C1 fractures are stable and can be treated nonoperatively with external immobilization. Traditional surgical options for C1 fracture treatment are occiput-to-C2 fusion or C1 with lateral mass screws (LMSs). Purpose - The aim is to assess the management and perioperative complications of C1 fractures undergoing LMS fusion between fluoroscopy and computed tomography (CT)-guided navigation.

Methods: This was a retrospective multicenter study of data from the DWG-Register of patients who underwent operative treatment for C1 traumatic fracture with LMSs from January 2017 to September 2022. Inclusion criteria - traumatic injury and age > 18 years old.

Results: In total, 202 patients with traumatic C1 fracture requiring spinal surgery were identified in the registry; = 175 (Group 1) were treated conventionally without CT-guided navigation and = 27 were treated with CT-guided navigation (Group 2). C1-LMS was principally performed by spine surgeons = 90 (53.4%) and = 72 (18.5%) by neurosurgeons in both the groups. Intraoperative adverse events were as follows: dural tear in group 1 = 0 and in group 2 = 1, vascular injury, with one case in group 1 and no cases in group 2. General complications were: cardiovasculars in group 1 = 6 (3.4%) and Group 2 = 4 (14.8%) ( = 0.03), pulmonary complications in group1 = 2 (1.1%) and = 9 in group 2 (33.3%) ( < 0.001), stroke = 1 (0.57%) in group1 and = 4 in group 2 (14.8%) ( < 0.001), gastrointestinal bleeding = 1 (0.57%) in group1 and no cases in group 2, renal insufficiency = 2 (1.1%) in group 1 and = 3 (11.1%) in group 2 ( = 0.01). One death was recorded in group 2 (3.7%).

Conclusion: This series of 404 screws placed in 202 patients over 5 years who underwent two types of C1 fracture fixation had a considerably lower incidence of screw malposition and vertebral artery injury than has previously been reported in the literature. C1 screws can be safely placed with a low risk of vertebral artery and neurologic injury with and without CT-guided navigation support.