Efficacy and Safety of Goel-Harms Technique in Upper Cervical Spine Surgery: A Systematic Review and Meta-Analysis.

Autor: Lvov I; Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia. Electronic address: dr.speleolog@gmail.com., Grin A; Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, 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, Moscow, Russia., Smirnov V; Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia., Kordonskiy A; Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia., Barbakadze Z; Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia., Abdrafiev R; Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia., Krylov V; Department of Neurosurgery, Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia; Department of Neurosurgery, Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2022 Nov; Vol. 167, pp. e1169-e1184. Date of Electronic Publication: 2022 Sep 08.
DOI: 10.1016/j.wneu.2022.09.016
Abstrakt: Objective: The main purpose of this systematic review and meta-analysis was to estimate the incidence of implant-associated complications and fusion rates for the Goel-Harms technique (GHT) and to show potential factors affecting the complications and nonunion development.
Methods: A systematic search of the PubMed database according to PRISMA guidance was performed. The main inclusion criteria comprised description of fusion rate and/or implant-associated complications rate.
Results: This systematic review included 86 articles focused on the results of surgery in 4208 patients. The rate of screw-related complications was as follows: 1) vertebral artery (VA) injury, 2.8%; 2) screw malposition in the direction of the VA, 5.8%; and 3) C2 nerve root irritation, 6.1%. The nonunion rate was 4.2%. Transpedicular screw insertion to the C1 and C2 vertebrae were the safest regarding VA injury and correlated with lower blood loss. For C1-C2 fusion, there was no statistical difference for the different bone graft localization. C2 nerve root irritation rate did not depend on screw insertion technique. The use of a freehand technique did not correlate with a high rate of screw-related complications.
Conclusions: The Goel-Harms technique is a promising method of C1-C2 fusion, with a relatively low nonunion and VA injury rate. It can be performed safely without C-arm or navigation system assistance. Transpedicular screw insertion trajectories to the C1 and C2 vertebrae were safest regarding VA injury and blood loss volume. Further comparative studies of various C1-C2 stabilization methods with a high level of significance should be carried out to identify the optimal approach.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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