gms | German Medical Science

67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12. - 15. Juni 2016, Frankfurt am Main

Is navigation required to avoid vertebral artery injury in C1/2- fusion?

Meeting Abstract

Suche in Medline nach

  • Timo Behm - Klinik für Neurochirurgie, Universitätsmedizin Göttingen, Germany
  • Dorothee Mielke - Klinik für Neurochirurgie, Universitätsmedizin Göttingen, Germany
  • Veit Rohde - Klinik für Neurochirurgie, Universitätsmedizin Göttingen, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocMI.04.09

doi: 10.3205/16dgnc257, urn:nbn:de:0183-16dgnc2576

Veröffentlicht: 8. Juni 2016

© 2016 Behm et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Injury of vertebral artery (VA) during C1/2- fusion is a feared complication. According to the literature, VA injury occurs in 5 to 20 % per patient, and up to 3 % per screw with lower rates in the C1 lateral mass / C2 isthmic (Harms), and higher rates in the transarticular (Magerl). Therefore, some authors recommend navigation for C1/C2 fixation irrespective of the technique used. Since half a decade, we are solely using the Harms fixation without navigation, allowing us to evaluate if navigation is truly necessary in order to avoid vascular injury.

Method: All patients with atlantoaxial instability treated with C1 lateral mass / C2 isthmic fusion between 2010 and 09/2015 at our institution were included in this retrospective analysis. Screw placement was postoperatively controlled by routine CT-scan. Location of screws was categorized in relation to VA canal/VA and compared to neurological outcome during hospital stay and follow-up visit three months after discharge. Categories of screw placement were: Grade 1: exclusively bony screw location, 2: parts of screw penetrating cortical bone of VA canal, 3: slight screw contact with VA, 4: suspected compression or injury of VA and subsequent vascular imaging, 5: compression or injury of VA and need for surgical revision or endovascular treatment.

Results: 144 screws were placed in 36 consecutive patients. 68 C1 screws were grade 1 (95%), 3 grade 2 (4%) and one grade 3 (1%). 30 C2 screws were grade 1 (42%), 23 grade 2 (32%), 18 grade 3 (25%), and 1 grade 4 (1%). Grade 5 screws were not found. In the single case of a grade 4 C2 screw, vascular imaging neither showed vascular injury nor relevant stenosis. In none of the patients a new neurological deficit occurred postoperatively. No screw was revised.

Conclusions: Despite a relative high rate of 25% of screws contacting the VA, neither vascular imaging nor clinical symptoms necessitated screw correction. Overall relevant vascular injury in C1 lateral mass / C2 isthmic (Harms) fixation seems to be rarer than published in the literature. Nevertheless in cases of suspected compression of vertebral artery additional vascular imaging should be performed. In the light of our results, we believe that navigation is dispensable using the Harms fixation technique.