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Accuracy and complications associated with freehand C1 lateral mass screw fixation technique:a radiographic and clinical assessment

Accuracy and complications associated with freehand C1 later...

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2014年浙江省骨科学学术年会

作者： Yong Hu Christopher K.Kepler todd j.albert Wei-hu Ma Rong-ming Xu Department of Spinal Surgery Ningbo No.6 Hospital Department of Orthopaedic Surgery Thomas Jefferson University & Rothman Institute

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Accuracy and complications associated with freehand C1 lateral mass screw fixation technique:a radiographic and clinical assessment

Accuracy and complications associated with freehand C1 later...

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2015年浙江省骨科学学术年会

作者： Yong Hu Christopher K.Kepler todd j.albert Wei-hu Ma Yong-jie Gu Rong-ming Xu Department of Spinal Surgery Ningbo No.6 Hospital Department of Orthopaedic Surgery Thomas Jefferson University & Rothman Institute

Study Design.A retrospective radiographic and clinical study of the technique for freehand C1 lateral mass screw(C1LMS) *** aims of this study were to evaluate a large series of posterior C1 LMS to determine accuracy based on computed tomography(CT) scan and assess perioperative complication rate related to errant screw *** of Background Data.C1 lateral mass fixation technique is frequently performed for upper cervical *** unique and variable C1 anatomy can make instrumentation at this level challenging and prone to potentially severe,even life-threatening complications such as vertebral artery or neurologic *** data were obtained from the medical record between january 2003 and December *** of screw placement was evaluated on postoperative reconstructive CT scan of 196 patients with atlantoaxial *** analysis included measurement of preoperative and postoperative CT scans to evaluate relevant anatomy and classify accuracy of instrumentation *** were graded using the following definitions:Type I,screw threads completely within the bone( "ideal");Type II,less than half the diameter of the screw violates the surrounding cortex( "safe");and Type III,clear violation of transverse foramen or spinal canal( "unacceptable").*** hundred ninety-six cases(107 males and 89 females) underwent posterior C1 LMS *** cases had unilateral C1 fixation applied because of specific pathology or anatomic constraints.A total of 390 C1 LMS were placed but 32 screws(8.2%) were excluded from accuracy measurements because of lack of postoperative CT scans;these patients were still included in the assessment of potential clinical complications based on clinical *** the 358 screws with postoperative CT imaging,85.5%of screws(Type Ⅰ) were rated as being in the ideal position,11.7%of screws(Type Ⅱ) were rated as occupying a " safe" position,and ten screws(2.8%) were "

关键词： C1 lateral mass screw Complications Atlas computed tomography

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Transoral reduction and osteosynthesis C1 as a functionpreserving option in the treatment of unstable jefferson fracture

Transoral reduction and osteosynthesis C1 as a functionprese...

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2016年浙江省骨科学学术年会

作者： Yong Hu Rong-ming Xu todd j.albert Wei-hu Ma Zhen-shan Yuan Wei-Xin Dong MD Department of Spinal Surgery Ningbo No.6 Hospital Department of Orthopaedic Surgery Thomas Jefferson University & Rothman Institute

Purpose The aim of this study is to illustrate a new method and surgical technique in the treatment of jefferson fractures which preserves the motion of the upper cervical *** and methods A retrospective review was performed of twelve patients with unstable jefferson fractures treated with transoral osteosynthesis of CI between july 2008 and December 2011.A steel plate and C1 lateral mass screw fixation were placed to repair the unstable jefferson *** study group included eight males and four females with the average age of 33 years(range,23-62 years).Results The patients were followed up for between 12 and 28 months after surgery(average 16 months).Range of motion of the cervical spine was approximately physiologic:average flexion 35°(range 28°-40°),average extension 42°(range 30°-48°).Lateral bending to the right and left averaged 30° and 28°,respectively(range,12°-36°,14°-32°,respectively).The average postoperative rotation of the atlantoaxial joint,evaluated by functional CT scan,was 60°(range 35°-72°).Total average lateral displacement of the lateral masses was 7.0 mm before surgery(range,5-12 mm) which improved to 3.5 mm after surgery(range 1-6.5 mm).The total average difference of the atlanto-dens interval in flexion-extension after surgery was 1.0 mm(range 1-3 mm).Conclusions Transoral osteosynthesis of the anterior ring using C1 lateral masses screws is a novel technique for treating unstable jefferson fractures which allows maintenance of rotation at the C1-C2 joint and restoration of congruency of the atlanto-occipital and atlantoaxial joints.

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Accuracy and complications associated with freehand C1 lateral mass screw fixation technique:a radiographic and clinical assessment

Accuracy and complications associated with freehand C1 later...

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2013中国工程院科技论坛暨浙江省骨科学学术年会

Study Design.A retrospective radiographic and clinical study of the technique for freehand C1 lateral mass screw(C1LMS) fixation. *** aims of this study were to evaluate a large series of posterior C1LMS to determine accuracy based on computed tomography(CT) scan and assess perioperative complication rate related to errant screw placement. Summary of Background Data.C1 lateral mass fixation technique is frequently performed for upper cervical *** unique and variable C1 anatomy can make instrumentation at this level challenging and prone to potentially severe,even life-threatening complications such as vertebral artery or neurologic injury. *** data were obtained from the medical record between january 2003 and December 2011. Accuracy of screw placement was evaluated on postoperative reconstructive CT scan of 196 patients with atlantoaxial *** analysis included measurement of preoperative and postoperative CT scans to evaluate relevant anatomy and classify accuracy of instrumentation *** were graded using the following definitions:TypeⅠ,screw threads completely within the bone("ideal");TypeⅡ,less than half the diameter of the screw violates the surrounding cortex("safe");and TypeⅢ,clear violation of transverse foramen or spinal canal("unacceptable"). *** hundred ninety-six cases(107 males and 89 females) underwent posterior CILMS fixation. Two cases had unilateral C1 fixation applied because of specific pathology or anatomic constraints.A total of 390 C1LMS were placed but 32 screws(8.2%) were excluded from accuracy measurements because of lack of postoperative CT scans;these patients were still included in the assessment of potential clinical complications based on clinical *** the 358 screws with postoperative CT imaging,85.5%of screws (TypeⅠ) were rated as being in the ideal position,11.7%of screws(TypeⅡ) were rated as occupying a " safe" position,and ten screws(2.8%) were "unaccep

关键词： C1 lateral mass screw Complications Atlas computed tomography

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Optimal entry points and trajectories for anterior C1 lateral mass screw

Optimal entry points and trajectories for anterior C1 latera...

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2015年浙江省骨科学学术年会

作者： Yong Hu Wei-xin Dong William Ryan Spiker todd j.albert Zhen-shan Yuan Xiao-yang Sun Hui Xie Department of Spinal Surgery Ningbo No.6 Hospital Department of Orthopaedic Surgery Thomas Jefferson University & Rothman Institute

BACKGROUND *** various posterior insertion angles and entry point for screw insertion have been proposed for posterior C1 lateral mass,no large series have been performed to assess the ideal entry point and optimal trajectory for anterior C1 lateral mass screw *** define the anatomy of the C1 lateral mass and make recommendations for optimal entry point and trajectories for anterior C1 lateral mass *** DESIGN.A radiographic analysis of the anatomy of the C1 lateral mass using CT scans and Mimics *** SAMPLE.A random sample of 62 cervical spine CT scans selected from a pool of patients’ films,these patients without medical or surgical pathology of the cervical *** *** anatomic measurements of C1 lateral mass made in the axial,coronal and sagittal planes of the CT scans by Mimics *** C1 lateral mass were evaluated using CT scanning with a 3D imaging application by Mimics *** transverse and sagittal angles were measured using the median sagittal plane and the axial plane as *** the space available for the anterior C1 lateral mass screw(SAS) of different transverse angles range from 0° to 30° with a uniform interval of 5°,to find out the ideal transverse *** the range of sagittal angle,to calculate the ideal sagittal *** measurements involving the height and width of the C1 lateral mass were also *** the transverse angle is 0,5,10,15,20,25,30 and β degrees,the space available for the anterior C1 lateral mass screw(SAS) were 8.39,9.00,9.54,9.98,10.13,9.31,7.94,10.57(mm) *** mean ideal transverse angle was 20.92°.The inside(h1),middle(h2) and outside(h3) effective height of the C1 lateral mass in front is 6.60,12.01 and 17.43(mm),the inside(H4),middle(H5) and outside(H6) effective height of the C1 lateral mass in back is 7.70,12.86 and 18.03(mm).The mean distance along the atlas anterior surface between the anterior

关键词： Atlas Anatomy Lateral mass screw Mimics Anterior

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Deviation analysis of atlanto-axial pedicle screws placement assisted by a novel rapid prototyping drill template:a cadaveric study

Deviation analysis of atlanto-axial pedicle screws placement...

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2014年浙江省骨科学学术年会

作者： Yong Hu Zhen-shan Yuan Christopher K.Kepler todd j.albert jian-bing Yuan Wei-xin Dong Cheng-tao Wang Department of Spinal Surgery Ningbo No.6 Hospital Department of Orthopaedic Surgery Thomas Jefferson University & Rothman Institute Institute of Biomedical Manufacturing and life Quality Engineering School of Mechanical and Power Energy EngineeringShanghai Jiaotong University

Study *** *** develop and validate the accuracy of a novel navigational template for C1-C2 pedicle screw(C1C2PS)placement in cadaveric *** of Background ***,C1C2PS are primarily positioned using a free-hand technique or under fluoroscopic guidance,their implementation is challenging due to the small size of the C1-C2 pedicle which places great technical demands on the *** insertion of screws,furthermore,has a potential risk of

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Transoral reduction and osteosynthesis C1 as a function-preserving option in the treatment of unstable jefferson fracture

Transoral reduction and osteosynthesis C1 as a function-pres...

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2014年浙江省骨科学学术年会

作者： Yong Hu Christopher K.Kepler Zhen-shan Yuan todd j.albert Wei-hu Ma Wei-xin Dong Rong-ming Xu Department of Spinal Surgery Ningbo No.6 Hospital Department of Orthopaedic Surgery Thomas Jefferson UniversityRothman Institute

Background:The majority of C fractures can be effectively treated conservatively by immobilization or traction unless there is an injury to the transverse atlantal *** treatment usually involves a long period of immobilization in a halo-vest,whereas surgical intervention generally involves fusion,eliminating the motion of the upper cervical *** propose a new method for the treatment of unstable jefferson fractures designed to avoid these problems.

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Conservative and operative treatment in the extension teardrop fracture of the axis

Conservative and operative treatment in the extension teardr...

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2014年浙江省骨科学学术年会

作者： Yong Hu Christopher K.Kepler todd j.albert Wei-hu Ma Zhen-shan Yuan Wei-xin Dong Rong-ming Xu Department of Spinal Surgery Ningbo No.6 Hospital Department of Orthopaedic Surgery Thomas Jefferson University & Rothman Institute

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Comparative the clinical and radiological outcome parameters between occipito-cervical and atlantoaxial fusion in treatment of the unstable jefferson fracture

Comparative the clinical and radiological outcome parameters...

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2015年浙江省骨科学学术年会

作者： Yong Hu Zhen-shan Yuan Christopher K.Kepler todd j.albert Wei-xin Dong Sun xiaoyang Wei-hu Ma Rong-ming Xu Department of Spinal Surgery Ningbo No.6 Hospital Department of Orthopaedic Surgery Thomas Jefferson University & Rothman Institute

Purpose Controversy exists concerning the management of unstable jefferson fractures,with some surgeons performing external reduction and immobilization of the patient in a Halo vest and others performing surgical reduction and internal *** purpose of this study is to compare the clinical and radiological outcome parameters between posterior atlanto-axial fusion(AAF) and occipito-cervical fusion(OCF) constructs in treatment of the unstable atlas *** In a retrospective evaluation of institutional databases,the authors reviewed medical records and original images obtained in 68 consecutive patients with Unstable jefferson fracture treated by AAF or OCF between October 2004 and March *** patients were divided into two surgical groups based on radiological findings and were treated with AAF(n=48,F/M:30:18) and OCF(n=20,F/M:13:7) *** blood loss,the time of the operation,the jOA Score,VAS Score,atlas-dens interval(ADI),lateral displacement of the lateral masses(LMD),complications,and the bone fusion rate were *** At the last followed up time,five incomplete paralysis patients(7.4%) showed postoperative improvement by more than 1 grade in their ASIA impairment *** patients with neck pain had relieved *** jOA score of AAF group had improved from 12.5±3.6 preoperatively to 15.7±2.3 postoperatively,the jOA score of OCF group had improved from 11.2±3.3 preoperatively to 14.8±4.2 postoperatively,the VAS score of AAF group had decreased from 4.8 ±1.5 preoperatively to 1.0±0.4 postoperatively,the VAS score of OCF group had decreased from 5.4±2.2 preoperatively to 1.3±0.9 ***,there was no difference in jOA Score and VAS Score between two groups.A statistically significant difference between pre- and post-operation showed the improvement of neurologic *** LMD average distance were 12.5 mm(8.2-16) and 14.6mm(10-19)respectively between AAF group and OCF group before surgery and decreased to

关键词： atlantoaxial fusion occipitocervical fusion jefferson fractures instrumentation

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Conservative and operative treatment in the extension teardrop fracture of the axis

Conservative and operative treatment in the extension teardr...

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2015年浙江省骨科学学术年会

作者： Yong Hu Christopher K.Kepler todd j.albert Wei-hu Ma Yongjie Gu Zhen-shan Yuan Wei-xin Dong Rong-ming Xu Department of Spinal Surgery Ningbo No.6 Hospital Department of Orthopaedic Surgery Thomas Jefferson University & Rothman Institute

Study Design. A retrospective case series describing teardrop fracture of the *** purpose of the present study was to clarify the clinical features,the mechanism of injury and potential instability of extension teardrop fracture of the axis,so as to emphasize the importance of recognizing this injury as a separate *** of Background *** fractures of the axis are rare spinal fractures,comprising only a small percentage of all injuries of the cervical *** exact mechanism of injury leading to teardrop fractures of the axis may not be identified in some cases and different injury mechanisms may lead to fracture which appear similar on *** stability of this fracture pattern is a matter of debate leading to controversy regarding treatment strategies and the need for *** retrospectively reviewed data from 16 patients to document mechanism of injury,neurological deficit,treatment and clinical outcome,and imaging *** imaging allowed documentation of the size and displacement of associated fragments,the presence of C2-3 subluxation,amount of prevertebral soft-tissue swelling(PVST),the presence of C2-3 disc injury,and the angle of rotation of the avulsed bony *** teardrop fractures accounted for approximately 8.9%of upper cervical spinal injuries and12.7%of axis fractures at authors’ institute over the same *** average age of all patients was 43.6 *** vehicle accidents(MVA)(56.3%) were the most common mechanism of *** patients(4 males and 2females) underwent surgery(4 via an anterior approach,2 cases via a posterior approach).Indications for surgery included:large fragment size,displacement or angulation,association of the fracture with disruption of the C2-3disc and compression of the esophagus by the displaced *** cases underwent halo vest immobilization for a period of time between 6 and 12 *** final follow-up,fourteen cases achieved ex

关键词： teardrop fracture Axis fracture upper cervical spine injury treatment

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