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Acta Neurochirurgica
Published in: Acta Neurochirurgica 10/2012

01-10-2012 | Clinical Article

Management of C2 fractures using Iso-C3D guidance: a single institution's experience

Authors: Sven R. Kantelhardt, Naureen Keric, Alf Giese

Published in: Acta Neurochirurgica | Issue 10/2012

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Abstract

Background

About 20 % of cervical fractures involve the C2 vertebra. Many surgical techniques have been proposed according to the type of fracture. However, morbidity and mortality of these procedures is often high, which can be attributed to the old age and significant co-morbidities of the affected population and the complex anatomy of C2. To target the latter, several authors have applied iso-C3D guidance for most of the common techniques. We here present our experience using a fixed protocol and iso-C3D guidance in all cases of traumatic C2 fractures.

Methods

Sixteen patients were operated upon between April 2011 and April 2012 using Iso-C3D guidance, following a fixed routine protocol. The screw position was verified by CT-scanning. Intraoperative and clinical parameters were evaluated.

Results

Six patients received anterior lag-screw fixation of odontoid fractures. Two underwent isolated posterior lag-screw fixation of hangman’s fracture. C1 and/or C3 lateral mass, and/or C2 isthmic screws were placed in eight patients. No screw had to be revised, 3 minor breachings of the cortical bone of <2 mm were observed.The same standard protocol for draping, registration of the navigation and Iso-C3D guided drilling could be applied for anterior and posterior procedures, leaving only two variables. This led to rapid acceptance of the technique among OR-staff and surgeons, who felt comfortable with iso-C3D guidance after only five cases.

Conclusions

Iso-C3D guidance is a safe and straightforward technique for anterior and posterior screw placement in the upper cervical spine.
Literature
1.
Böhler J (1982) Anterior stabilization for acute fractures and non-unions of the dens. J Bone Joint Surg Am 64(1):18–27PubMed
2.
Börm W, König RW, Albrecht A, Richter HP, Kast E (2004) Percutaneous transarticular atlantoaxial screw fixation using a cannulated screw system and image guidance. Minim Invasive Neurosurg 47(2):111–114PubMedCrossRef
3.
Denaro V, Papalia R, Di Martino A, Denaro L, Maffulli N (2011) The best surgical treatment for type II fractures of the dens is still controversial. Clin Orthop Relat Res 469(3):742–750PubMedCrossRef
4.
Greenberg MS (2006) Handbook of neurosurgery, 6th edn. Thieme medical publishers, New York, p 724
5.
Grob D, Magerl F (1987) Operative stabilisierung bei frakturen von C1 und C2. Orthopäde 16(1):46–54PubMed
6.
Martirosyan NL, Kalb S, Cavalcanti DD, Lochhead RA, Uschold TD, Loh A, Theodore N (2004) Comparative Analysis of Isocentric 3-dimensional C-arm Fluoroscopy and Biplanar Fluoroscopy for Anterior Screw Fixation in Odontoid Fractures. J Spinal Disord Tech. PMID:22158300
7.
Molinari RW, Khera OA, Gruhn WL, McAssey RW (2011) Rigid cervical collar treatment for geriatric type II odontoid fractures. Eur Spine J. PMID:22094387
8.
Rajasekaran S, Vidyadhara S, Shetty AP (2007) Iso-C3D fluoroscopy-based navigation in direct pedicle screw fixation of hangman fracture: a case report. J Spinal Disord Tech 20(8):616–619PubMedCrossRef
9.
Ringel F, Reinke A, Stüer C, Meyer B, Stoffel M (2012) Posterior C1-2 fusion with C1 lateral mass and C2 isthmic screws: accuracy of screw position, alignment and patient outcome. Acta Neurochir (Wien) 154(2):305–312CrossRef
10.
Sugimoto Y, Ito Y, Shimokawa T, Shiozaki Y, Mazaki T (2010) Percutaneous screw fixation for traumatic spondylolisthesis of the axis using iso-C3D fluoroscopy-assisted navigation (case report). Minim Invasive Neurosurg 53(2):83–85PubMedCrossRef
11.
Terterov S, Taghva A, Khalessi AA, Hsieh PC (2011) Symptomatic vertebral artery compression by the rod of a C1-C2 posterior fusion construct: case report and review of the literature. Spine 36(10):E678–E681PubMedCrossRef
12.
Tessitore E, Bartoli A, Schaller K, Payer M (2011) Accuracy of freehand fluoroscopy-guided placement of C1 lateral mass and C2 isthmic screws in atlanto-axial instability. Acta Neurochir (Wien) 153(7):1417–1425CrossRef
13.
Tian W, Weng C, Liu B, Li Q, Hu L, Li ZY, Liu YJ, Sun YZ (2011) Posterior fixation and fusion of unstable hangman’s fracture by using intraoperative three-dimensional fluoroscopy-based navigation. Eur Spine J. PMID:22109567
14.
Yang YL, Fu BS, Li RW, Smith PN, Mu WD, Li LX, Zhou DS (2011) Anterior single screw fixation of odontoid fracture with intraoperative Iso-C 3-dimensional imaging. Eur Spine J 20(11):1899–1907PubMedCrossRef
15.
Yang YL, Zhou DS, He JL (2011) Comparison of Isocentric C-Arm 3-Dimensional Navigation and Conventional Fluoroscopy for C1 Lateral Mass and C2 Pedicle Screw Placement for Atlantoaxial Instability. J Spinal Disord Tech. PMID:22105103
Metadata
Title
Management of C2 fractures using Iso-C3D guidance: a single institution's experience
Authors
Sven R. Kantelhardt
Naureen Keric
Alf Giese
Publication date
01-10-2012
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 10/2012
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-012-1443-9

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