Transoral Decompression and Stabilization of the Upper Cervical Segments of the Spine Using Custom-Made Implants in Various Pathologic Conditions of the Craniovertebral Junction.

Autor: Shkarubo AN; Department of Neurooncology, N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia., Kuleshov AA; Department of Vertebrology, N. N. Priorov Central Institute of Traumatology and Orthopedics, Moscow, Russia., Chernov IV; Department of Neurooncology, N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia. Electronic address: ilch@list.ru., Vetrile MS; Department of Vertebrology, N. N. Priorov Central Institute of Traumatology and Orthopedics, Moscow, Russia., Lisyansky IN; Department of Vertebrology, N. N. Priorov Central Institute of Traumatology and Orthopedics, Moscow, Russia., Makarov SN; Department of Vertebrology, N. N. Priorov Central Institute of Traumatology and Orthopedics, Moscow, Russia., Ponomarenko GP; Department of Vertebrology, N. N. Priorov Central Institute of Traumatology and Orthopedics, Moscow, Russia., Spyrou M; Ygeia Private Hospital, Limassol, Cyprus.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2018 Jan; Vol. 109, pp. e155-e163. Date of Electronic Publication: 2017 Sep 27.
DOI: 10.1016/j.wneu.2017.09.124
Abstrakt: Background: Surgical treatment of patients with atlantoaxial instability caused by pathologic changes of the skull base and craniovertebral junction combined with anterior compression of the brain stem is still associated with substantial technical difficulties and remains a matter of debate. Currently, anterior stabilization of the atlantoaxial junction is a promising approach that allows for the resection of the pathologic lesion of the skull base and craniovertebral junction with subsequent stabilization of C1-C2 or C1-C3 in 1 stage.
Methods: In this article, we present 5 clinical cases in which transoral decompression and anterior stabilization of the C1-C2 (4 cases) and C1-C3 (1 case of anteroposterior stabilization) segments with custom-made fixation systems was used to treat various pathologic conditions of the craniovertebral junction.
Results: In all cases, complete removal of the pathologic lesion and decompression of the upper cervical spinal cord as well as reliable stabilization of the upper spinal segments were achieved. Some degree of movement in the cervical spine was preserved in all patients due to unfixed C0-C1 and C3-C7 segments in 4 cases and C0-C1 and C4-C7 in 1 case. Implant migration or instability was not observed in any of the cases. The follow-up period was from 1 to 4 years after surgery.
Conclusions: The first experience of anterior fixation using individually manufactured C1-C2 and C1-C3 systems demonstrated their effectiveness. This approach can be safely used as an alternative or in combination with standard posterior stabilization methods. An innovative surgical technology developed and implemented in our surgical practice allows for optimization of the surgical technique, reduces the number of perioperative complications, eliminates movement restrictions in the cervical spine, improves motor activity, and makes earlier patient rehabilitation possible.
(Copyright © 2017 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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