Transpedicular fixation in fracture-dislocations of the cervical spine: Two years' experience

SÜTPİDELER, Neslihan; ŞENGÖZ, Ahmet; KOTİL, kadir; ANTAR, Veysel

Transpedicular fixation in fracture-dislocations of the cervical spine: Two years' experience

Kadir KOTİL, (İstanbul Eğitim ve Araştırma Hastanesi, Nöroşirürji Kliniği, İstanbul, Türkiye)

Ahmet ŞENGÖZ, (İstanbul Eğitim ve Araştırma Hastanesi, Nöroşirürji Kliniği, İstanbul, Türkiye)

Neslihan SÜTPİDELER, (İstanbul Eğitim ve Araştırma Hastanesi, Nöroşirürji Kliniği, İstanbul, Türkiye)

Veysel ANTAR (İstanbul Eğitim ve Araştırma Hastanesi, Nöroşirürji Kliniği, İstanbul, Türkiye)

Journal of Turkish Spinal Surgery

2 2

Yıl: 2010 Cilt: 21 Sayı: 3 Sayfa Aralığı: 249 - 260 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Transpedicular fixation in fracture-dislocations of the cervical spine: Two years' experience

Öz:

Amaç: Anterior ya da posterior yaklaşımla transpediküler fiksasyon tekniği servikal kırıklıçıkıkta biyomekanik olarak kuvvetli bir metot olarak bilinmektedir. Bu çalışmada pedikül aksları, vida giriş noktalarının pedikül oryantasyonu ile eşleştirilmesi amacıyla, floroskopi ile belirlenmiş, instabil servikal kırıklıçıkık için pedikül vidası ile fiksasyon (PVF) yapılan hastalarda tekniğin klinik sonuçları ve güvenilirliği tartışılmıştır. Metot: Travma nedeniyle opere edilen 12 hastanın 52 pedikülüne takılan transpediküler vidaların postoperatif malpozisyonu araştırılmıştır. C3 ve C7 arası fiksasyon yapılmış ve iliak kanat ve laminalar füzyon için otogreft olarak kullanılmıştır. Sonuçlar: Hastaların sekizi erkek, dördü kadındı. Hastaların ortalama yaşı 40.9 idi (34-65). Vakaların 12'sinde neden travma idi; 4'ünde unilateral, 8'inde bilateral kırıklı-çıkık mevcuttu. Bunların beşi C5-C6 segmentinde, dördü C4-C5 segmentinde ve kalan üçü ise C6-C7 segmentindeydi. Postoperatif bilgisayarlı tomografi (BT) incelemelerinde, takılan vidanın direk olarak vertebral foramene penetrasyonu sadece bir vakada (% 1,9) görüldü; ancak anjiyografide kan akımı normaldi. Vida-pedikül ilişkisine bakıldığında, 45 pedikülde (% 86,5) vidalar doğru yerleşimde iken 3'ünde (% 5,7) kritik olmayan pediküler lateral oryantasyon ve 4'ünde (% 7,6) medial oryantasyon saptandı. Vakalar 14 ile 31 ay boyunca (ortalama 24.7 ay) takip edildi. Tümünde posterior kemik füzyon oluşurken, mortalite ya da morbidite oluşmadı. Sonuç: PVF kullanımı çok güçlü üç kolon stabilizasyonu sağlamakla beraber sinir hasarı olmaksızın vasküler hasar riski taşır. Postoperatif BT görüntülemelerinde yerleştirilen 52 vidanın bulunduğu bir pedikülde (%1,9) majör hasar ve yedi pedikülde ( %13,2) minör hasar tespit edildi. PVF travma hastalarında anterior cerrahiye ihtiyaç duyulmaksızın tek seanslık bir posterior cerrahi girişim olarak uygulanabilir.

Anahtar Kelime:

Konular: Cerrahi

Servikal fraktür dislokasyonda transpediküler vida fiksasyonu: İki yıllık deneyim

Öz:

Object: Transpedicular fixation technique, by means of anterior or posterior approaches, is known to be a biomechanically stronger method in cervical fracture-dislocation. Pedicle axis views are obtained using fluoroscopy to match the screw entry point with pedicle orientation and to report the clinical results and safety of cervical pedicle screw fixation (CPSF) in patients treated for unstable cervical fracture -dislocation. Methods: Post-operative malposition of the transpedicular screws of the 52 pedicles of the 12 patients who have been operated due to trauma were investigated. Fixation was performed between C3 and C7, and iliac wing and lamina were used as autograft for fusion. Results: Eight of the cases were male, while four were female. The average age of the patients was 40.9 (34-65). 12 of the cases had trauma; 4 had unilateral, 8 had bilateral fracture dislocation. Five of these were at the C5-C6 segment, four in C6-7 segment, while the other three were at the C6-C7 segment. In the postoperative computed tomography (CT) scans, the applied screw was observed to have directly penetrated into the vertebral foramen in only one (1.9 %) pedicle during the fixation process; however, the blood circulation appeared normal in angiography. In terms of screw-pedicle relations, the screws were at their correct places in 45 pedicles (86.5 %), while non-critical pedicular lateral orientation was detected in 3 (5.7 %), and medial orientation in another 4 pedicles (7.6 %). The cases were followed up for a total of 14 to 31 months (24.7). Solid posterior bone fusion was achieved in all, there is no morbidity or mortality in this series. Conclusion: Use of the CPSF provides a very strong three column stabilization but also carries a high risk of vascular injury without nerve damage. Postoperative CT scanning showed major breach in one pedicle (1.9 %) and minor breach in 7 pedicles (13.2 %) of 52 screws that had perforated the pedicle. CPSF can be performed in a one stage posterior procedure without the need of anterior surgery in trauma patients.

Anahtar Kelime:

Konular: Cerrahi

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Anderson PA, Henley MB, Grady MS. Posterior cervical arthrodesis with AO reconstruction plates and bone graft. Spine 1991; 16 (3 Suppl): S72-79.
2. Abumi K, Kaneda K. Pedicle screw fixation for nontraumatic lesions of the cervical spine. Spine 1997; 22(16): 1853–1863.
3. Abumi K, Kaneda K, Shono Y, Fujiya M. Onestage posterior decompression and reconstruction of the cervical spine by using pedicle screw fixation systems. J Neurosurg 1999; 90(1 Suppl): 19-26.
4. Abumi K, Shono Y, Ito M, Taneichi H, Kotani Y, Kaneda K. Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine 2000; 25(8): 962–969.
5. Bale RJ, Hoser C, Rosenberger R,.Rieger M, Benedetto KP, Fink C. Osteochondral lesions of the talus: computer-assisted retrograde drilling-feasibility and accuracy in initial experiences. Radiology 2001; 218(1): 278–282.
6. Borne GM, Bedeu GL, Pinaudeau M. Treatment of pedicular fractures of the axis. A clinical study and screw fixation technique. J Neurosurg 1984; 60(1): 88-93.
7. Fehlings MG, Cooper PR, Errico TJ. Posterior plates in the management of cervical instability: long-term results in 44 patients. J Neurosurg 1994; 81(3): 341-349.
8. Garfin SR, Moore MR. Marshall LF. A modified technique for cervical facet fusions. Clin Orthop Relat Res 1988; (230): 149-153.
9. Heller JG, Silcox DH 3rd, Sutterlin CE 3rd Complications of posterior cervical plating. Spine 1995; 20(22): 2442-2448.
10. Holly LT, Foley KT. Percutaneous placement of posterior cervical screws using three- dimensional fluoroscopy. Spine 2006; 31(5): 536–540.
11. Jones EL, Heller JG, Silcox DH, Hutton WC. Cervical pedicle screws versus lateral mass screws. Anatomic feasibility and biomechanical comparison. Spine 1997; 22(9): 977-982.
12. Karaikovic EE, Yingsakmongkol W, Gaines RW Jr. Accuracy of cervical pedicle screw placement using the funnel technique. Spine 2001; 26(22): 2456-2462.
13. Kotani Y, Cunningham BW, Abumi K, McAfee PC. Biomechanical analysis of cervical stabilization systems. An assessment of transpedicular screw fixation in the cervical spine. Spine 1994; 19(22): 2529-2539.
14. Kothe R, Ruther W, Schneider E, Linke B. Biomechanical analysis of transpedicular screw fixation in the subaxial cervical spine. Spine 2004; 29(17): 1869–1887.
15. Ludwig SC, Kramer DL, Balderston RA, Vaccaro AR, Foley KF, Albert TJ. Placement of pedicle screws in the human cadaveric cervical spine: comparative accuracy of three techniques. Spine 2000; 25(13): 1655–1667.
16. McCullen GM, Garfin SR. Spine update: cervical spine internal fixation using screw and screw-plate constructs. Spine 2000; 25(5): 643-652.
17. Neo M, Sakamoto T, Fujibayashi S, Nakamura T. The clinical risk of vertebral artery injury from cervical pedicle screws inserted in degenerative vertebrae. Spine 2005; 30(24): 2800–2805
18. Rampersaud YR, Simon DA, Foley KT. Accuracy requirements for image-guided spinal pedicle screw placement. Spine 2001; 26(4): 352–359.
19. Rath SA, Moszko S, Schäffner PM, Cantone G, Braun V, Richter HP, Antoniadis G. Accuracy of pedicle screw insertion in the cervical spine for internal fixation using frameless stereotactic guidance. J Neurosurg Spine 2008; 8(3): 237-245.
20. Reichle E, Sellenschloh K, Morlock M, Eggers C. Placement of pedicle screws using different navigation systems. A laboratory trial with 12 spinal preparations. Orthopade 2002; 31(4): 368–371.
21. Reinhold M, Magerl F, Rieger M,.Blauth M. Cervical pedicle screw placement: feasibility and accuracy of two new insertion techniques based on morphometric data. Eur Spine J 2007; 16(1): 47–56.
22. Reinhold M, Bach C, Audigé L, Bale R, Attal R, Blauth M, Magerl F. Comparison of two novel fluoroscopy-based stereotactic methods for cervical pedicle screw placement and review of the literature. Eur Spine J 2008; 7(4): 564-575.
23. Richter M, Amiot L, Neller S, Kluger P. Computer-assisted surgery in posterior instrumentation of the cervical spine: an invitro feasibility study. Eur Spine J 2000; 9 Suppl 1: 65-70.
24. Richter M, Cakir B, Schmidt R. Cervical pedicle screws: conventional versus computer-assisted placement of cannulated screws. Spine 2005; 30(20): 2280–2287.
25. Rezcallah AT, Xu R, Ebraheim NA, Jackson T. Axial computed tomography of the pedicle in the lower cervical spine. Am J Orthop 2001; 30(1): 59–61.
26. Sakamoto T, Neo M, Nakamura T. Transpedicular screw placement evaluated by axial computed tomography of the cervical pedicle. Spine 2004; 29(22): 2510–2514.
27. Ugur HC, Attar A, Uz A. Surgical anatomic evaluation of the cervical pedicle and adjacent neural structures. Neurosurgery 2000 ; 47(5): 1162–1168.
28. Yusof MI, Ming LK, Abdullah MS, Yusof AH. Computerized tomographic measurement of the cervical pedicles diameter in a Malaysian population and the feasibility for transpedicular fixation. Spine 2006; 31(8): E221–E224.

APA	KOTİL k, ŞENGÖZ A, SÜTPİDELER N, ANTAR V (2010). Transpedicular fixation in fracture-dislocations of the cervical spine: Two years' experience. , 249 - 260.
Chicago	KOTİL kadir,ŞENGÖZ Ahmet,SÜTPİDELER Neslihan,ANTAR Veysel Transpedicular fixation in fracture-dislocations of the cervical spine: Two years' experience. (2010): 249 - 260.
MLA	KOTİL kadir,ŞENGÖZ Ahmet,SÜTPİDELER Neslihan,ANTAR Veysel Transpedicular fixation in fracture-dislocations of the cervical spine: Two years' experience. , 2010, ss.249 - 260.
AMA	KOTİL k,ŞENGÖZ A,SÜTPİDELER N,ANTAR V Transpedicular fixation in fracture-dislocations of the cervical spine: Two years' experience. . 2010; 249 - 260.
Vancouver	KOTİL k,ŞENGÖZ A,SÜTPİDELER N,ANTAR V Transpedicular fixation in fracture-dislocations of the cervical spine: Two years' experience. . 2010; 249 - 260.
IEEE	KOTİL k,ŞENGÖZ A,SÜTPİDELER N,ANTAR V "Transpedicular fixation in fracture-dislocations of the cervical spine: Two years' experience." , ss.249 - 260, 2010.
ISNAD	KOTİL, kadir vd. "Transpedicular fixation in fracture-dislocations of the cervical spine: Two years' experience". (2010), 249-260.

APA	KOTİL k, ŞENGÖZ A, SÜTPİDELER N, ANTAR V (2010). Transpedicular fixation in fracture-dislocations of the cervical spine: Two years' experience. Journal of Turkish Spinal Surgery, 21(3), 249 - 260.
Chicago	KOTİL kadir,ŞENGÖZ Ahmet,SÜTPİDELER Neslihan,ANTAR Veysel Transpedicular fixation in fracture-dislocations of the cervical spine: Two years' experience. Journal of Turkish Spinal Surgery 21, no.3 (2010): 249 - 260.
MLA	KOTİL kadir,ŞENGÖZ Ahmet,SÜTPİDELER Neslihan,ANTAR Veysel Transpedicular fixation in fracture-dislocations of the cervical spine: Two years' experience. Journal of Turkish Spinal Surgery, vol.21, no.3, 2010, ss.249 - 260.
AMA	KOTİL k,ŞENGÖZ A,SÜTPİDELER N,ANTAR V Transpedicular fixation in fracture-dislocations of the cervical spine: Two years' experience. Journal of Turkish Spinal Surgery. 2010; 21(3): 249 - 260.
Vancouver	KOTİL k,ŞENGÖZ A,SÜTPİDELER N,ANTAR V Transpedicular fixation in fracture-dislocations of the cervical spine: Two years' experience. Journal of Turkish Spinal Surgery. 2010; 21(3): 249 - 260.
IEEE	KOTİL k,ŞENGÖZ A,SÜTPİDELER N,ANTAR V "Transpedicular fixation in fracture-dislocations of the cervical spine: Two years' experience." Journal of Turkish Spinal Surgery, 21, ss.249 - 260, 2010.
ISNAD	KOTİL, kadir vd. "Transpedicular fixation in fracture-dislocations of the cervical spine: Two years' experience". Journal of Turkish Spinal Surgery 21/3 (2010), 249-260.