Artikel
Posteriorfusion as correction of craniocervical and atlantoaxial instability in patients with traumatic lesions using O-Arm system
Die Anwendung dorsaler Instrumentierung bei traumatisch bedingten atlantoaxialen und kraniozervikalen Instabilitäten bei älteren Patienten unter Zuhilfenahme des O-Arms
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Veröffentlicht: | 8. Mai 2019 |
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Objective: A prospective analysis of the surgical treatment and results of 84 patients with traumatic craniocervical and atlantoaxial lesions operated during 60-month period (2011-2016) at our Department was performed. The aim of the analysis was to assess the factors affecting posterior fusion for correction of craniocervical and atlantoaxial instability.
Methods: We analyzed 54 patients with odontoid fractures, 19 patients with combine craniocervical und atlantoaxial fracture and 11 patients with hangman’s fracture. In 84 patients we performed 102 operations. Because of craniocervical/cervical instability we performed posterior screw fixation in all of 84 patients. In 39 patients we additionally performed decompression.
Results: In order to improve screw placement accuracy we used intraoperative navigation (O-Arm) in 70 cases and in 14 patients we used X-ray (C-Arm) equipment. The operative duration was 2 hours in O-Arm operations and 4 hours in C-arm operation. The blood loss was 300 ml in O-Arm and 550ml in C-Arm procedures. The mean screw length in C1 and C2 vertebras was 30 mm in O-Arm procedures and 24 mm in C-Arm procedures. The most common surgical complications were: brainstem infarction – in 1 case, CSF leak – in 2 cases, postoperative infection – in 5 cases, screw misplacement - in 2 cases ( in C-Arm procedures ) and 1 case with early preoperative mortality. The 24-months follow-up showed good recovery in 79 patients, moderate disabling – 25 patients, severe disabling – 5 patients, vegetative state – 4 patients, death 5 patients with malignant lesions.
Conclusion: Early correction of craniocervical and high cervical instability facilitated neurological recovery by preserving the existent neurological function. The use of O-Arm increases operative screw placement accuracy, and prevents intraoperative nerve and vertebral artery injury. The complication rate in O-Arm procedure in craniocervical/atlantoaxial area is significantly lower, than in procedure with X-ray equipment in this area. Recently because of the improvement of neuroimaging techniques, operative approaches, surgical techniques and neurointensive care the results of treatment of these lesions are optimal.