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Surgical management of symptomatic os odontoideum with posterior screw fixation performed using the magerl and harms techniques with intraoperative 3-dimensional fluoroscopy-based navigation.

Abstract：

STUDY DESIGN:Retrospective case series. OBJECTIVE:To evaluate the accuracy of screw fixation using intraoperative three-dimensional fluoroscopy-based navigation (ITFN) and to assess the clinical outcomes of this treatment regimen. SUMMARY OF BACKGROUND DATA:The surgical management of symptomatic os odontoideum poses considerable difficulties due to the highly variable anatomy of the upper cervical spine and surrounding neurovascular structures. Various methods have been described for the treatment of symptomatic os odontoideum, all of which have limitations. METHODS:Nineteen patients with symptomatic os odontoideum were investigated. Pain scores were assessed using the visual analogue scale. Myelopathy was assessed using the Nurick scale and Odom's criteria. Radiological imaging was carried out in all patients for diagnosis and to assess the atlantodens interval, space available for cord, and presence of intramedullary hyperintensity signals on T2-weighted images at the C1-C2 level. Posterior stabilization was performed for all patients by using ITFN. RESULTS:The mean Nurick score improved from 2.3 before surgery to 0.7 at the time of follow-up. The mean follow-up period was 34.7 months (range, 12-65 mo). According to Odom's criteria, outcomes were as follows: excellent, 47%; good, 37%; fair, 11%; and poor, 5%. All patients with preoperative neck pain had symptom relief or improvement, with all of these patients having more than 83.7% improvement in visual analogue scale scores. The mean preoperative space available for cord value of 9.3 mm improved to 17.7 mm. Solid fusion and reduction of atlantoaxial dislocation were achieved in every patient without screw failure. Sixty screws were placed in 19 patients. Two C2 polyaxial screws in 2 patients and 1 transarticular screw in 1 patient slightly penetrated the transverse foramen with no vascular injury and clinical sequelae. CONCLUSION:ITFN is a safe, accurate, and effective tool for screw placement in patients with symptomatic os odontoideum.

journal_name

Spine (Phila Pa 1976)

journal_title

Spine

authors

Weng C,Tian W,Li ZY,Liu B,Li Q,Wang YQ,Sun YZ

doi

10.1097/BRS.0b013e3182578fd8

subject

Has Abstract

pub_date

2012-10-01 00:00:00

pages

1839-46

issue

eissn

0362-2436

issn

1528-1159

journal_volume

pub_type

杂志文章

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Surgical management of symptomatic os odontoideum with posterior screw fixation performed using the magerl and harms techniques with intraoperative 3-dimensional fluoroscopy-based navigation.