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Motion-Preserving Navigated Primary Internal Fixation of Unstable C1 Fractures

STUDY DESIGN: Prospective observational study. PURPOSE: To assess the safety, efficacy, and benefits of computed tomography (CT)-guided C1 fracture fixation. OVERVIEW OF LITERATURE: The surgical management of unstable C1 injuries by occipitocervical and atlantoaxial (AA) fusion compromises motion an...

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Autores principales: Rajasekaran, Shanmuganathan, Soundararajan, Dilip Chand Raja, Shetty, Ajoy Prasad, Kanna, Rishi Mugesh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Society of Spine Surgery 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7435319/
https://www.ncbi.nlm.nih.gov/pubmed/32050311
http://dx.doi.org/10.31616/asj.2019.0189
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author Rajasekaran, Shanmuganathan
Soundararajan, Dilip Chand Raja
Shetty, Ajoy Prasad
Kanna, Rishi Mugesh
author_facet Rajasekaran, Shanmuganathan
Soundararajan, Dilip Chand Raja
Shetty, Ajoy Prasad
Kanna, Rishi Mugesh
author_sort Rajasekaran, Shanmuganathan
collection PubMed
description STUDY DESIGN: Prospective observational study. PURPOSE: To assess the safety, efficacy, and benefits of computed tomography (CT)-guided C1 fracture fixation. OVERVIEW OF LITERATURE: The surgical management of unstable C1 injuries by occipitocervical and atlantoaxial (AA) fusion compromises motion and function. Monosegmental C1 osteosynthesis negates these drawbacks and provides excellent functional outcomes. METHODS: The patients were positioned in a prone position, and cranial traction was applied using Mayfield tongs to restore the C0–C2 height and obtain a reduction in the displaced fracture fragments. An intraoperative, CT-based navigation system was used to enable the optimal placement of C1 screws. A transverse rod was then placed connecting the two screws, and controlled compression was applied across the fixation. The patients were prospectively evaluated in terms of their clinical, functional, and radiological outcomes, with a minimal follow-up of 2 years. RESULTS: A total of 10 screws were placed in five patients, with a mean follow-up of 40.8 months. The mean duration of surgery was 77±13.96 minutes, and the average blood loss was 84.4±8.04 mL. The mean combined lateral mass dislocation at presentation was 14.6±1.34 mm and following surgery, it was 5.2±1.64 mm, with a correction of 9.4±2.3 mm (p <0.001). The follow-up CT showed excellent placement of screws and sound healing. There were no complications and instances of AA instability. The clinical range of movement at 2 years in degrees was as follows: rotation to the right (73.6°±9.09°), rotation to the left (71.6°±5.59°), flexion (35.4°±4.5°), extension (43.8°±8.19°), and lateral bending on the right (28.4°±10.45°) and left (24.8°±11.77°). Significant improvement was observed in the functional Neck Disability Index from 78±4.4 to 1.6±1.6. All patients returned to their occupation within 3 months. CONCLUSIONS: Successful C1 reduction and fixation allows a motion-preserving option in unstable atlas fractures. CT navigation permits accurate and adequate monosegmental fixation with excellent clinical and radiological outcomes, and all patients in this study returned to their preoperative functional status.
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spelling pubmed-74353192020-08-24 Motion-Preserving Navigated Primary Internal Fixation of Unstable C1 Fractures Rajasekaran, Shanmuganathan Soundararajan, Dilip Chand Raja Shetty, Ajoy Prasad Kanna, Rishi Mugesh Asian Spine J Clinical Study STUDY DESIGN: Prospective observational study. PURPOSE: To assess the safety, efficacy, and benefits of computed tomography (CT)-guided C1 fracture fixation. OVERVIEW OF LITERATURE: The surgical management of unstable C1 injuries by occipitocervical and atlantoaxial (AA) fusion compromises motion and function. Monosegmental C1 osteosynthesis negates these drawbacks and provides excellent functional outcomes. METHODS: The patients were positioned in a prone position, and cranial traction was applied using Mayfield tongs to restore the C0–C2 height and obtain a reduction in the displaced fracture fragments. An intraoperative, CT-based navigation system was used to enable the optimal placement of C1 screws. A transverse rod was then placed connecting the two screws, and controlled compression was applied across the fixation. The patients were prospectively evaluated in terms of their clinical, functional, and radiological outcomes, with a minimal follow-up of 2 years. RESULTS: A total of 10 screws were placed in five patients, with a mean follow-up of 40.8 months. The mean duration of surgery was 77±13.96 minutes, and the average blood loss was 84.4±8.04 mL. The mean combined lateral mass dislocation at presentation was 14.6±1.34 mm and following surgery, it was 5.2±1.64 mm, with a correction of 9.4±2.3 mm (p <0.001). The follow-up CT showed excellent placement of screws and sound healing. There were no complications and instances of AA instability. The clinical range of movement at 2 years in degrees was as follows: rotation to the right (73.6°±9.09°), rotation to the left (71.6°±5.59°), flexion (35.4°±4.5°), extension (43.8°±8.19°), and lateral bending on the right (28.4°±10.45°) and left (24.8°±11.77°). Significant improvement was observed in the functional Neck Disability Index from 78±4.4 to 1.6±1.6. All patients returned to their occupation within 3 months. CONCLUSIONS: Successful C1 reduction and fixation allows a motion-preserving option in unstable atlas fractures. CT navigation permits accurate and adequate monosegmental fixation with excellent clinical and radiological outcomes, and all patients in this study returned to their preoperative functional status. Korean Society of Spine Surgery 2020-08 2020-02-14 /pmc/articles/PMC7435319/ /pubmed/32050311 http://dx.doi.org/10.31616/asj.2019.0189 Text en Copyright © 2020 by Korean Society of Spine Surgery 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 Clinical Study
Rajasekaran, Shanmuganathan
Soundararajan, Dilip Chand Raja
Shetty, Ajoy Prasad
Kanna, Rishi Mugesh
Motion-Preserving Navigated Primary Internal Fixation of Unstable C1 Fractures
title Motion-Preserving Navigated Primary Internal Fixation of Unstable C1 Fractures
title_full Motion-Preserving Navigated Primary Internal Fixation of Unstable C1 Fractures
title_fullStr Motion-Preserving Navigated Primary Internal Fixation of Unstable C1 Fractures
title_full_unstemmed Motion-Preserving Navigated Primary Internal Fixation of Unstable C1 Fractures
title_short Motion-Preserving Navigated Primary Internal Fixation of Unstable C1 Fractures
title_sort motion-preserving navigated primary internal fixation of unstable c1 fractures
topic Clinical Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7435319/
https://www.ncbi.nlm.nih.gov/pubmed/32050311
http://dx.doi.org/10.31616/asj.2019.0189
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