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Occipital-C2 transarticular fixation for occipitocervical instability associated with occipitalization of the atlas in patients with klippel-feil syndrome, using intraoperative 3-dimensional navigation system.
Spine (Phila Pa 1976) 2013; 38(8):642-9S

Abstract

STUDY DESIGN

Retrospective case series.

OBJECTIVE

The aim of this study was to describe the clinical outcomes of cervical reduction and occipital-C2 transarticular (OCTA) fixation with an assistance of intraoperative 3-dimensional navigation system (ITNS) during the treatment of reducible occipitocervical instability (OCI) in patients with Klippel-Feil syndrome (KFS) with occipitalization of the atlas and fusion of C2-C3.

SUMMARY OF BACKGROUND DATA

Patients with KFS have congenital fusions of at least 2 cervical segments and may gradually develop symptoms at the hypermobile articulations adjacent to the cervical synostosis. This is particularly common in patients with KFS with occipitalization of the atlas and C2-C3 fusion. These patients may be at risk for instability and neurological complications of the occipitocervical junction that require occipitocervical reconstruction and fusion. Numerous treatment techniques are available for this pathological condition. However, there has yet to be a study of reducible OCI, showing successful treatment with intraoperative reduction and posterior OCTA fixation using ITNS.

METHODS

From 2006 to 2011, 9 patients with KFS with reducible OCI attributed to occipitalization of the atlas and C2-C3 fusion were surgically treated. After a limited foramen magnum decompression, reduction of the OCI was conducted by intraoperative cervical traction and extension, followed by OCTA fixation using a direct posterior approach and with the assistance of ITNS. The follow-up period ranged from 6 to 60 months (mean, 31 mo).

RESULTS

Good decompression and bone fusion were achieved in all the patients. The clinical symptoms had improved for all patients. There were no intraoperative or postoperative complications.

CONCLUSION

In patients with KFS with occipitalization of the atlas and C2-C3 fusion, manual cervical traction in tandem with cervical extension, followed by posterior OCTA fixation and fusion provides a safe, effective treatment of OCI and ventral brainstem impingement. IFTN is a feasible tool for monitoring cervical reduction and OCTA screw insertion in patients with KFS with this pathological condition.

Authors+Show Affiliations

Department of Spine Surgery, Peking University Fourth Clinical Medical College, Beijing Jishuitan Hospital, Beijing, China. orthdanielcw@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23124258

Citation

Tian, Wei, et al. "Occipital-C2 Transarticular Fixation for Occipitocervical Instability Associated With Occipitalization of the Atlas in Patients With Klippel-feil Syndrome, Using Intraoperative 3-dimensional Navigation System." Spine, vol. 38, no. 8, 2013, pp. 642-9.
Tian W, Weng C, Li Q, et al. Occipital-C2 transarticular fixation for occipitocervical instability associated with occipitalization of the atlas in patients with klippel-feil syndrome, using intraoperative 3-dimensional navigation system. Spine. 2013;38(8):642-9.
Tian, W., Weng, C., Li, Q., Liu, B., Sun, Y. Q., Yuan, Q., ... He, D. (2013). Occipital-C2 transarticular fixation for occipitocervical instability associated with occipitalization of the atlas in patients with klippel-feil syndrome, using intraoperative 3-dimensional navigation system. Spine, 38(8), pp. 642-9. doi:10.1097/BRS.0b013e31827a330a.
Tian W, et al. Occipital-C2 Transarticular Fixation for Occipitocervical Instability Associated With Occipitalization of the Atlas in Patients With Klippel-feil Syndrome, Using Intraoperative 3-dimensional Navigation System. Spine. 2013 Apr 15;38(8):642-9. PubMed PMID: 23124258.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Occipital-C2 transarticular fixation for occipitocervical instability associated with occipitalization of the atlas in patients with klippel-feil syndrome, using intraoperative 3-dimensional navigation system. AU - Tian,Wei, AU - Weng,Chong, AU - Li,Qin, AU - Liu,Bo, AU - Sun,Yu-Qing, AU - Yuan,Qiang, AU - Xing,Yong-Gang, AU - He,Da, PY - 2012/11/6/entrez PY - 2012/11/6/pubmed PY - 2013/10/29/medline SP - 642 EP - 9 JF - Spine JO - Spine VL - 38 IS - 8 N2 - STUDY DESIGN: Retrospective case series. OBJECTIVE: The aim of this study was to describe the clinical outcomes of cervical reduction and occipital-C2 transarticular (OCTA) fixation with an assistance of intraoperative 3-dimensional navigation system (ITNS) during the treatment of reducible occipitocervical instability (OCI) in patients with Klippel-Feil syndrome (KFS) with occipitalization of the atlas and fusion of C2-C3. SUMMARY OF BACKGROUND DATA: Patients with KFS have congenital fusions of at least 2 cervical segments and may gradually develop symptoms at the hypermobile articulations adjacent to the cervical synostosis. This is particularly common in patients with KFS with occipitalization of the atlas and C2-C3 fusion. These patients may be at risk for instability and neurological complications of the occipitocervical junction that require occipitocervical reconstruction and fusion. Numerous treatment techniques are available for this pathological condition. However, there has yet to be a study of reducible OCI, showing successful treatment with intraoperative reduction and posterior OCTA fixation using ITNS. METHODS: From 2006 to 2011, 9 patients with KFS with reducible OCI attributed to occipitalization of the atlas and C2-C3 fusion were surgically treated. After a limited foramen magnum decompression, reduction of the OCI was conducted by intraoperative cervical traction and extension, followed by OCTA fixation using a direct posterior approach and with the assistance of ITNS. The follow-up period ranged from 6 to 60 months (mean, 31 mo). RESULTS: Good decompression and bone fusion were achieved in all the patients. The clinical symptoms had improved for all patients. There were no intraoperative or postoperative complications. CONCLUSION: In patients with KFS with occipitalization of the atlas and C2-C3 fusion, manual cervical traction in tandem with cervical extension, followed by posterior OCTA fixation and fusion provides a safe, effective treatment of OCI and ventral brainstem impingement. IFTN is a feasible tool for monitoring cervical reduction and OCTA screw insertion in patients with KFS with this pathological condition. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/23124258/Occipital_C2_transarticular_fixation_for_occipitocervical_instability_associated_with_occipitalization_of_the_atlas_in_patients_with_klippel_feil_syndrome_using_intraoperative_3_dimensional_navigation_system_ L2 - http://dx.doi.org/10.1097/BRS.0b013e31827a330a DB - PRIME DP - Unbound Medicine ER -