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Surgical Intervention for Unstable Craniovertebral Junction Anomalies with Narrow C2 Pedicle.
World Neurosurg. 2017 Jul; 103:647-654.WN

Abstract

OBJECTIVE

We sought to investigate and report a novel surgical technique of screws insertion and posterior surgical reduction, as well as explore its clinical results.

METHODS

From September 2008 to September 2012, we treated 41 cases of unstable craniovertebral junction anomalies with a narrow C2 pedicle at our department. All patients underwent "posterior reduction and internal fixation of the occipital bone with superior or inferior articular process of C2 and lateral mass of C3 on the narrowed C2 pedicle side-for non-narrowed C2 pedicle side, the screw was only inserted into C2 pedicle without extending the fixation to C3 vertebrae-using a titanium screw-rod (plate) fixation system." The preoperative and postoperative atlantodens interval, Chamberlain line, McRae line, and cervicomedullary angle were all measured. In addition, the preoperative and postoperative Japanese Orthopedic Association score was used to evaluate the cervical myelopathy.

RESULTS

A total of 134 screws were inserted into the C2 pedicle (30 screws), superior (35 screws) or inferior (17 screws) articular process of C2, and lateral mass of C3 (52 screws). There was a significant statistical difference between the preoperative and postoperative results in the reduction of the odontoid process, decompression of the upper cervical spinal cord and medulla, as well as the improvement of neurologic functions (P < 0.05). All patients have exhibited a major neurologic improvement and solid bony fusion.

CONCLUSION

This novel surgical technique is safe, feasible, and effective for the treatment of unstable craniovertebral junction anomalies with a narrow C2 pedicle.

Authors+Show Affiliations

Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.National Center for Neurological Sciences, Khartoum, Sudan.Department of Neurosurgery, Specialized Arab Hospital, Nablus, Palestine.Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Chongqing Medical University, Chongqing, China.Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. Electronic address: yanyi2005@vip.sina.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28457924

Citation

Darwazeh, Rami, et al. "Surgical Intervention for Unstable Craniovertebral Junction Anomalies With Narrow C2 Pedicle." World Neurosurgery, vol. 103, 2017, pp. 647-654.
Darwazeh R, Liu Q, Deng L, et al. Surgical Intervention for Unstable Craniovertebral Junction Anomalies with Narrow C2 Pedicle. World Neurosurg. 2017;103:647-654.
Darwazeh, R., Liu, Q., Deng, L., Xia, J., Elzain, M. A., Darwazeh, M., Sharma, P., Zhang, B., & Yan, Y. (2017). Surgical Intervention for Unstable Craniovertebral Junction Anomalies with Narrow C2 Pedicle. World Neurosurgery, 103, 647-654. https://doi.org/10.1016/j.wneu.2017.04.124
Darwazeh R, et al. Surgical Intervention for Unstable Craniovertebral Junction Anomalies With Narrow C2 Pedicle. World Neurosurg. 2017;103:647-654. PubMed PMID: 28457924.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical Intervention for Unstable Craniovertebral Junction Anomalies with Narrow C2 Pedicle. AU - Darwazeh,Rami, AU - Liu,Qiang, AU - Deng,Lei, AU - Xia,Jiajie, AU - Elzain,Mohammed A, AU - Darwazeh,Mazhar, AU - Sharma,Piyush, AU - Zhang,Bo, AU - Yan,Yi, Y1 - 2017/04/27/ PY - 2017/03/07/received PY - 2017/04/17/revised PY - 2017/04/18/accepted PY - 2017/5/2/pubmed PY - 2017/9/26/medline PY - 2017/5/2/entrez KW - Atlantoaxial dislocation KW - Craniovertebral junction anomalies KW - Narrow C(2) pedicle KW - Reduction KW - Screw insertion KW - Vertebral artery injury SP - 647 EP - 654 JF - World neurosurgery JO - World Neurosurg VL - 103 N2 - OBJECTIVE: We sought to investigate and report a novel surgical technique of screws insertion and posterior surgical reduction, as well as explore its clinical results. METHODS: From September 2008 to September 2012, we treated 41 cases of unstable craniovertebral junction anomalies with a narrow C2 pedicle at our department. All patients underwent "posterior reduction and internal fixation of the occipital bone with superior or inferior articular process of C2 and lateral mass of C3 on the narrowed C2 pedicle side-for non-narrowed C2 pedicle side, the screw was only inserted into C2 pedicle without extending the fixation to C3 vertebrae-using a titanium screw-rod (plate) fixation system." The preoperative and postoperative atlantodens interval, Chamberlain line, McRae line, and cervicomedullary angle were all measured. In addition, the preoperative and postoperative Japanese Orthopedic Association score was used to evaluate the cervical myelopathy. RESULTS: A total of 134 screws were inserted into the C2 pedicle (30 screws), superior (35 screws) or inferior (17 screws) articular process of C2, and lateral mass of C3 (52 screws). There was a significant statistical difference between the preoperative and postoperative results in the reduction of the odontoid process, decompression of the upper cervical spinal cord and medulla, as well as the improvement of neurologic functions (P < 0.05). All patients have exhibited a major neurologic improvement and solid bony fusion. CONCLUSION: This novel surgical technique is safe, feasible, and effective for the treatment of unstable craniovertebral junction anomalies with a narrow C2 pedicle. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/28457924/Surgical_Intervention_for_Unstable_Craniovertebral_Junction_Anomalies_with_Narrow_C2_Pedicle_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(17)30632-0 DB - PRIME DP - Unbound Medicine ER -