gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Three-dimensional modelling for posterior fixation in craniocervical instability

Meeting Abstract

  • T. Ohtonari - Dept. of Spinal Surgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Hiroshima, Japan
  • S. Ota - Dept. of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Hiroshima, Japan
  • N. Nishihara - Dept. of Spinal Surgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Hiroshima, Japan
  • K. Suwa - Dept. of Spinal Surgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Hiroshima, Japan
  • T. Ota - Dept. of Spinal Surgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Hiroshima, Japan
  • T. Koyama - Clinical Institute for Spinal Disorders, Otsu, Shiga, Japan

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocSA.09.01

DOI: 10.3205/12dgnc362, URN: urn:nbn:de:0183-12dgnc3629

Published: June 4, 2012

© 2012 Ohtonari et al.
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Outline

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Objective: When deciding on the optimal surgical strategy for posterior fixation in craniocervical instability, it is essential to obtain precise knowledge of both the location of the vertebral arteries (VA) and the morphology of atlas and axis preoperatively. Herein, we report consecutive 11 operated cases with craniocervical instability in which three-dimensional (3D) models were used for preoperative planning.

Methods: A full-scale 3D model of the craniocervical junction area was created preoperatively for each individual patient. The plaster models were produced by way of a rapid prototyping technique of layered manufacturing, based on multiplaner reconstruction images from 3D computed tomographic (CT) angiography covering an area from the occiput to the middle cervical spine. All patients were placed in supine and reduction position on the CT table. The 3D models were created for a total of 11 patients (5 males and 6 females, age range 32–78 years) with craniocervical instability. The details regarding the diseases of these patients were as follows: rheumatoid arthritis, 4 cases; os odontoideum, 3 cases; odontoid process type II fracture, 1 case; and idiopathic subluxation, 3 cases. We planned each surgical strategy by actually applying implants to these 3D models before surgery. Only the fluoroscope was used as a support tool during the operation.

Results: In the first 2 cases, we installed 3 posterior atlantoaxial transarticular screws (TAS), as described by Magerl. In one of these 2 cases, fixation was performed between the C1 atlas claw and the C2 pedicle screw (PS) on one side. In all the other 9 cases, the applied implants were as follows: C0; 2 midline occipital plates, C1; 13 lateral mass screws (LMS) and 1 atlas claw, C2; 8 PS, 8 laminar screws (LS) and 3 axis claws, C3; 2 LMS, C3/4; 2 TAS, and C4/5; 2 TAS. In all 11 cases, stabilization was achieved in perfect accordance with the preoperative plans, and postoperative courses were good.

Conclusions: Navigation systems are certainly a useful support for the accurate installation of implants in the spine. However, it offers also both palpable technical help and solid reassurance to the surgeon to conduct a preoperative trial installation of implants on a 3D model of the craniocervical complex of the patient. This certainly applies to the posterior fixation of craniocervical instability, and possibly also beyond.