Characteristics of Screw Perforation and Screw Loosening in Atlantoaxial Transarticular Fixation Using a Preoperative Computed Tomography-Based Navigation System.

IF 1.7 Q2 SURGERY
Masashi Uehara, Shota Ikegami, Hiroki Oba, Yoshinari Miyaoka, Takayuki Kamanaka, Terue Hatakenaka, Takuma Fukuzawa, Koji Hayashi, Jun Takahashi
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引用次数: 0

Abstract

Background: Atlantoaxial transarticular fixation, also called the Magerl technique, is said to be the most robust biomechanical method of fixation of the atlantoaxial vertebrae. However, the procedure carries a risk of spinal cord and vertebral artery injury during the insertion process, especially in patients with a high-riding vertebral artery. In this study, a computed tomography (CT)-based navigation system was used for preoperative planning and insertion. This investigation sought to determine the rate and direction of screw perforation as well as the incidence of screw loosening in computer-assisted atlantoaxial transarticular fixation.

Methods: Sixty patients (31 men and 29 women; mean ± SD age: 65.3 ± 19.6 years) who received atlantoaxial transarticular screw insertion with preoperative CT navigation were analyzed. We investigated screw position and loosening by CT at the final follow-up.

Results: Of the 108 screws inserted, the rate of Grade 2 or higher perforation was 4.6% (5/108). Nine of 81 (11.1%) screws inserted into the 44 patients who were followed for at least 6 months showed loosening. Logistic regression analysis revealed that unilateral insertion (odds ratio: 8.50, 95% confidence interval: 1.53-47.2, P = 0.014) was significantly associated with the incidence of screw loosening.

Conclusions: The screw perforation rate of Grade 2 or higher in computer-assisted atlantoaxial transarticular screw fixation was 4.6%, with comparable frequencies of perforation direction. Unilateral insertion was a significant independent factor associated with screw loosening, which occurred in 11.1% of insertions.

Clinical relevance: Spine surgeons should follow up with patients with caution because screws with unilateral insertion are prone to loosening.

Level of evidence: 4:

使用术前计算机断层扫描导航系统进行寰枢椎经关节固定术中螺钉穿孔和螺钉松动的特征。
背景:寰枢椎经关节固定术,又称 Magerl 技术,据说是固定寰枢椎最稳固的生物力学方法。然而,该手术在插入过程中存在脊髓和椎动脉损伤的风险,尤其是在椎动脉高位患者中。本研究采用基于计算机断层扫描(CT)的导航系统进行术前规划和插入。这项研究旨在确定计算机辅助寰枢椎经关节固定术中螺钉穿孔的比率和方向以及螺钉松动的发生率:分析了 60 例接受寰枢椎经关节螺钉植入术的患者(男性 31 例,女性 29 例;平均 ± SD 年龄:65.3 ± 19.6 岁),他们在术前均接受了 CT 导航。我们在最后随访时通过 CT 调查了螺钉的位置和松动情况:在插入的108枚螺钉中,2级或以上穿孔率为4.6%(5/108)。在接受至少 6 个月随访的 44 位患者中,81 枚螺钉中有 9 枚(11.1%)出现松动。逻辑回归分析显示,单侧插入(几率比:8.50,95% 置信区间:1.53-47.2,P = 0.014)与螺钉松动的发生率显著相关:计算机辅助寰枢椎经关节螺钉固定术中2级或以上的螺钉穿孔率为4.6%,穿孔方向的频率相当。单侧插入是与螺钉松动相关的重要独立因素,11.1%的插入发生了螺钉松动:临床意义:脊柱外科医生应谨慎随访患者,因为单侧插入的螺钉容易发生松动:4:
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.10
自引率
0.00%
发文量
162
期刊介绍: The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.
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