| 1. |
- Bodon, Gergely, et al.
(författare)
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Anatomical changes in occipitalization : is there an increased risk during the standard posterior approach?
- 2013
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Ingår i: European spine journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 22:3 suppl., s. 512-516
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE:The purpose of this study was to examine the anatomic changes in a case of occipitalization of the atlas.METHODS:Occipitalization of the atlas was found accidentally in a 64-year-old male cadaver. Anatomic dissection was carried out to examine the posterior aspect of the upper cervical region and craniocervical junction. The occipitalized atlas was then harvested and macerated to study the bony anomaly.RESULTS:In this case of occipitalization, fusion was observed at both lateral masses and at the left posterior hemiarch of the atlas. We found the following soft tissue changes: the rectus capitis posterior minor muscle was lacking on the left side and was atrophic on the right, the obliquus capitis superior muscle was present on both sides showing moderate atrophy and fatty changes. The posterior atlanto-axial membrane was thinner and asymmetric, had a free edge on the right side. Lateral to this edge the dura was lying free. We believe that these changes of the posterior atlanto-axial membrane together with the increased distance between the fused posterior arch of the atlas and the lamina of the axis could cause the observed "dura bulge" at this level. The vertebral artery was entering the skull through a canal on the left side.CONCLUSIONS:In our case, occipitalization considerably changed the anatomy of the upper cervical spine and craniocervical junction. Special care must be taken when using the posterior approach to avoid neurovascular injury in cases with occipitalization.
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| 2. |
- Bodon, Gergely, et al.
(författare)
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Applied anatomy of a minimally invasive muscle-splitting approach to posterior C1-C2 fusion : an anatomical feasibility study
- 2014
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Ingår i: Surgical and Radiologic Anatomy. - : Springer Science and Business Media LLC. - 0930-1038 .- 1279-8517. ; 36:10, s. 1063-1069
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE:To describe the applied anatomy of a minimally invasive muscle-splitting approach used to reach the posterior aspect of the C1-C2 complex.SUMMARY OF BACKGROUND DATA:Atlantoaxial fusion using a midline posterior approach and polyaxial screw and rod system is widely used. Although minimally invasive variations of this technique have been recently reported, the complex applied anatomy of these approaches has not been described. The C1-C2 complex represents an unique challenge because of its bony and vascular anatomy. In this study, the applied anatomy and feasibility of this technique are examined on cadavers.METHODS:The microsurgical anatomy of the upper cervical spine is examined on a formalin-fixed and on a fresh cadaver. The muscle-splitting approach is performed on 12 fresh cadavers using this technique.RESULTS:The minimally invasive muscle-splitting approach is described in detail. Relevant anatomy and bony landmarks that aid screw placement in C1 and C2 could be well visualized. Using this approach, we were able to reach the lateral mass of the atlas and the inferior articular process and pars interarticularis of the axis in all of the nine cadavers. We placed mini polyaxial screws in C1 lateral mass and C2 pars interarticularis in four cadavers according to the technique described by Harms and Melcher.CONCLUSIONS:Using this approach, it was possible to reach the posterior aspect of C1 and C2; the relevant anatomy needed to perform a C1-C2 fusion could be well visualized.
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| 3. |
- Kitamura, Kazuya, et al.
(författare)
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Evaluating a paradigm shift from anterior decompression and fusion to muscle-preserving selective laminectomy : a single-center study of degenerative cervical myelopathy
- 2022
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Ingår i: Journal of Neurosurgery. - : American Association of Neurological Surgeons. - 1547-5654 .- 1547-5646. ; 37:5, s. 740-748
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Muscle-preserving selective laminectomy (SL) is an alternative to conventional decompression surgery in patients with degenerative cervical myelopathy (DCM). It is less invasive, preserves the extensor musculature, and maintains the range of motion of the cervical spine. Therefore, the preferred treatment for DCM at the authors' institution has changed from anterior decompression and fusion (ADF), including anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF), toward SL. The aim of this study was to evaluate surgical outcomes before and after this paradigm shift with patient-reported outcome measures (PROMs), complications, reoperations, and cost-effectiveness.METHODS: This study was a retrospective register-based cohort study. All patients with DCM who underwent ADF or SL at the authors' institution from 2008 to 2019 were reviewed. Using ANCOVA, changes in PROMs from baseline to the 2-year follow-up were compared between the two groups, adjusting for clinicodemographic parameters, baseline PROMs, number of decompressed levels, and MRI measurements (C2-7 Cobb angle, C2-7 sagittal vertical axis [SVA], and modified K-line interval [mK-line INT]). The PROMs, including the European Myelopathy Score (EMS), the Neck Disability Index (NDI), and the EQ-5D, were collected from the national Swedish Spine Register. Complications, reoperations, and in-hospital treatment costs were also compared between the two groups.RESULTS: Ninety patients (mean age 60.7 years, 51 men [57%]) were included in the ADF group and 63 patients (mean age 68.8 years, 41 men [65%]) in the SL group. The ADF and SL groups had similar PROMs at baseline. The preoperative MR images showed similar C2-7 Cobb angles (10.7° [ADF] vs 14.1° [SL], p = 0.12) and mK-line INTs (4.08 vs 4.88 mm, p = 0.07), but different C2-7 SVA values (16.2 vs 19.3 mm, p = 0.04). The comparison of ANCOVA-adjusted mean changes in PROMs from baseline to the 2-year follow-up presented no significant differences between the groups (EMS, p = 0.901; NDI, p = 0.639; EQ-5D, p = 0.378; and EQ-5D health, p = 0.418). The overall complication rate was twice as high in the ADF group (22.2% vs 9.5%, p = 0.049), while the reoperation rate was comparable (16.7% vs 7.9%, p = 0.146). The average in-hospital treatment cost per patient was $6617 (USD) for SL, $7046 for ACDF, and $12,000 for ACCF.CONCLUSIONS: SL provides similar PROMs after 2 years, a significantly lower complication rate, and better cost-effectiveness compared with ADF.
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| 4. |
- MacDowall, Anna, et al.
(författare)
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Surgical treatment outcome on a national cohort of 176 patients with cervical manifestation of rheumatoid arthritis.
- 2021
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Ingår i: Journal of Craniovertebral Junction and Spine. - : Medknow Publications. - 0974-8237 .- 0976-9285. ; 12:3, s. 248-256
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Rheumatoid arthritis (RA) affecting the cervical spine results in instability and deformity that can be divided into the subtypes C1-C2 horizontal (atlantoaxial instability), C0-C2 vertical (basilar invagination), subaxial, and combined instabilities. The aim of this study was to compare the surgical treatments and outcomes of RA-related deformity and instability in a population-based setting.Patients and Methods: All patients with RA in the national Swespine register from January 1, 2006, to March 20, 2019, were assessed. Baseline characteristics, surgical treatments, European Myelopathy Scale (EMS), Neck Disability Index, the Visual Analog Scale for neck and arm pain as well as pre- and postoperative imaging were analyzed. The follow-up time points were at 1-, 2-, and 5 years after surgery.Results: A total of 176 patients were included. There were 62 (35%) patients with C1-C2 horizontal instability, 48 (27%) with C0-C2 vertical instability, 19 (11%) patients with subaxial instability, 43 (24%) patients with combined instability, and 4 patients without instability served as controls. The EMS improved in the C1-C2 horizontal instability group after fusion surgery (Δ =2.6 p) but remained within baseline confidence intervals in the other groups. All patients regardless of instability improved in pain. The subaxial instability had the highest risk of death within 5 years after surgery (11/19, 58%). The most dangerous complications due to implant failure were seen in patients instrumented with laminar hooks.Conclusion: The neurological outcome after fusion surgery is poor and the death rate is high in patients with cervical RA-related instability and deformity.
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