Fluoroscopic landmarks and trajectories for safe posterior percutaneous transarticular C1-C2 screw insertion: a CT-based simulation study.

Autor: Lvov I; Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, B. Suharevskaya Pl. 3, Moscow, 107945, Russia. dr.speleolog@gmail.com., Grin A; Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, B. Suharevskaya Pl. 3, Moscow, 107945, Russia.; Department of Neurosurgery, Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia., Talypov A; Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, B. Suharevskaya Pl. 3, Moscow, 107945, Russia., Barbakadze Z; Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, B. Suharevskaya Pl. 3, Moscow, 107945, Russia., Abdrafiev R; Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, B. Suharevskaya Pl. 3, Moscow, 107945, Russia., Krylov V; Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, B. Suharevskaya Pl. 3, Moscow, 107945, Russia.; Department of Neurosurgery, Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.
Jazyk: angličtina
Zdroj: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society [Eur Spine J] 2021 Jun; Vol. 30 (6), pp. 1651-1661. Date of Electronic Publication: 2021 Jan 31.
DOI: 10.1007/s00586-021-06744-0
Abstrakt: Purpose: To determine the safe screw trajectory for posterior transarticular fixation of C1-C2 without direct visualisation of C2 lateral masses and by using fluoroscopic landmarks only.
Methods: Fluoroscopic models of the craniovertebral region in frontal and sagittal planes were reconstructed using 1-mm interval computed tomography scans of the cervical spine in 30 patients. The imitation model of the screw trajectory was then applied with verification of the exact screw localisation using multiplanar reconstruction. Twenty-seven trajectories for 60 oblique C1-C2 reformations were tested.
Results: In the frontal plane, all correct trajectories passed through the medial waistline point (WstP) of C3 and through the middle of the lateral mass of C1. In the lateral plane, the posterior spinal process-lateral mass (SpLM) point-middle C1 anterior tuberculum point (ATP), middle SpLM-upper ATP, and lower SpLM-odontoid point (ODP)-had relatively low rates of vertebral artery (VA) injury (2.3%, 4.6%, and 7%, respectively) and other screw malpositions (6.9%, 4.6%, and 4.6%, respectively). In cases of an isthmus height exceeding 8 mm, there were no incidences of VA injury. Patients with an isthmus width greater than 7 mm had a lower risk of screw malposition.
Conclusion: We identified potentially safe trajectories for percutaneous posterior transarticular fixation of C1-C2. Using SpLM, ATP, and ODP landmarks in the lateral plane, and WstP and C1 middle landmarks in the frontal plane, it is possible to achieve an acceptable screw position without direct visualisation of the C2 lateral mass.
(© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.)
Databáze: MEDLINE
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