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Additional Surgical Method Aimed to Increase Distractive Force during Occipitocervical Stabilization : Technical Note
OBJECTIVE: Craniovertebral junctional anomalies constitute a technical challenge. Surgical opening of atlantoaxial joint region is a complex procedure especially in patients with nuchal deformity like basilar invagination. This region has actually very complicated anatomical and functional character...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Korean Neurosurgical Society
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5853194/ https://www.ncbi.nlm.nih.gov/pubmed/29526072 http://dx.doi.org/10.3340/jkns.2017.0197 |
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author | Antar, Veysel Turk, Okan |
author_facet | Antar, Veysel Turk, Okan |
author_sort | Antar, Veysel |
collection | PubMed |
description | OBJECTIVE: Craniovertebral junctional anomalies constitute a technical challenge. Surgical opening of atlantoaxial joint region is a complex procedure especially in patients with nuchal deformity like basilar invagination. This region has actually very complicated anatomical and functional characteristics, including multiple joints providing extension, flexion, and wide rotation. In fact, it is also a bottleneck region where bones, neural structures, and blood vessels are located. Stabilization surgery regarding this region should consider the fact that the area exposes excessive and life-long stress due to complex movements and human posture. Therefore, all options should be considered for surgical stabilization, and they could be interchanged during the surgery, if required. METHODS: A 53-year-old male patient applied to outpatients’ clinic with complaints of head and neck pain persisting for a long time. Physical examination was normal except increased deep tendon reflexes. The patient was on long-term corticosteroid due to an allergic disease. Magnetic resonance imaging and computed tomography findings indicated basilar invagination and atlantoaxial dislocation. The patient underwent C0–C3–C4 (lateral mass) and additional C0–C2 (translaminar) stabilization surgery. RESULTS: In routine practice, the sites where rods are bound to occipital plates were placed as paramedian. Instead, we inserted lateral mass screw to the sites where occipital screws were inserted on the occipital plate, thereby creating a site where extra rod could be bound. When C2 translaminar screw is inserted, screw caps remain on the median plane, which makes them difficult to bind to contralateral system. These bind directly to occipital plate without any connection from this region to the contralateral system. Advantages of this technique include easy insertion of C2 translaminar screws, presence of increased screw sizes, and exclusion of pullout forces onto the screw from neck movements. Another advantage of the technique is the median placement of the rod; i.e., thick part of the occipital bone is in alignment with axial loading. CONCLUSION: We believe that this technique, which could be easily performed as adjuvant to classical stabilization surgery with no need for special screw and rod, may improve distraction force in patients with low bone density. |
format | Online Article Text |
id | pubmed-5853194 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Korean Neurosurgical Society |
record_format | MEDLINE/PubMed |
spelling | pubmed-58531942018-03-21 Additional Surgical Method Aimed to Increase Distractive Force during Occipitocervical Stabilization : Technical Note Antar, Veysel Turk, Okan J Korean Neurosurg Soc Technical Note OBJECTIVE: Craniovertebral junctional anomalies constitute a technical challenge. Surgical opening of atlantoaxial joint region is a complex procedure especially in patients with nuchal deformity like basilar invagination. This region has actually very complicated anatomical and functional characteristics, including multiple joints providing extension, flexion, and wide rotation. In fact, it is also a bottleneck region where bones, neural structures, and blood vessels are located. Stabilization surgery regarding this region should consider the fact that the area exposes excessive and life-long stress due to complex movements and human posture. Therefore, all options should be considered for surgical stabilization, and they could be interchanged during the surgery, if required. METHODS: A 53-year-old male patient applied to outpatients’ clinic with complaints of head and neck pain persisting for a long time. Physical examination was normal except increased deep tendon reflexes. The patient was on long-term corticosteroid due to an allergic disease. Magnetic resonance imaging and computed tomography findings indicated basilar invagination and atlantoaxial dislocation. The patient underwent C0–C3–C4 (lateral mass) and additional C0–C2 (translaminar) stabilization surgery. RESULTS: In routine practice, the sites where rods are bound to occipital plates were placed as paramedian. Instead, we inserted lateral mass screw to the sites where occipital screws were inserted on the occipital plate, thereby creating a site where extra rod could be bound. When C2 translaminar screw is inserted, screw caps remain on the median plane, which makes them difficult to bind to contralateral system. These bind directly to occipital plate without any connection from this region to the contralateral system. Advantages of this technique include easy insertion of C2 translaminar screws, presence of increased screw sizes, and exclusion of pullout forces onto the screw from neck movements. Another advantage of the technique is the median placement of the rod; i.e., thick part of the occipital bone is in alignment with axial loading. CONCLUSION: We believe that this technique, which could be easily performed as adjuvant to classical stabilization surgery with no need for special screw and rod, may improve distraction force in patients with low bone density. Korean Neurosurgical Society 2018-03 2018-02-28 /pmc/articles/PMC5853194/ /pubmed/29526072 http://dx.doi.org/10.3340/jkns.2017.0197 Text en Copyright © 2018 The Korean Neurosurgical Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Technical Note Antar, Veysel Turk, Okan Additional Surgical Method Aimed to Increase Distractive Force during Occipitocervical Stabilization : Technical Note |
title | Additional Surgical Method Aimed to Increase Distractive Force during Occipitocervical Stabilization : Technical Note |
title_full | Additional Surgical Method Aimed to Increase Distractive Force during Occipitocervical Stabilization : Technical Note |
title_fullStr | Additional Surgical Method Aimed to Increase Distractive Force during Occipitocervical Stabilization : Technical Note |
title_full_unstemmed | Additional Surgical Method Aimed to Increase Distractive Force during Occipitocervical Stabilization : Technical Note |
title_short | Additional Surgical Method Aimed to Increase Distractive Force during Occipitocervical Stabilization : Technical Note |
title_sort | additional surgical method aimed to increase distractive force during occipitocervical stabilization : technical note |
topic | Technical Note |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5853194/ https://www.ncbi.nlm.nih.gov/pubmed/29526072 http://dx.doi.org/10.3340/jkns.2017.0197 |
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