Lukas Bobinski, Linda Sandberg, Frida Bylander, Hampus Hållberg, Anders Berglund, John M. Duff
{"title":"颅颈交界处 3d 透视导航器械 C2 神经根切除新改良技术的安全性和有效性","authors":"Lukas Bobinski, Linda Sandberg, Frida Bylander, Hampus Hållberg, Anders Berglund, John M. Duff","doi":"10.1007/s00701-024-06265-x","DOIUrl":null,"url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Purpose</h3><p>Instrumentation of the C1 vertebra requires either mobilization or transection of the C2 nerve root. This study investigates clinical and radiological outcomes and incidences of C2 neuropathic pain after posterior instrumented fusion in the cranio-cervical junction with or without division of the C2 nerve roots.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>This retrospective study compared two cohorts of patients who underwent instrumented fusion in the cranio-cervical junction. Fifty patients (22 males and 28 females) were operated with complete resection of C2 nerve root ganglion (Ex group), and fifty-one patients (30 men, 21 women) with C2 nerve roots preservation (No group).</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The incidence of postoperative C2 neuropathy was eight times lower in the Ex group compared to the No group that was statistical significant, <i>p</i> = 0.039. Surgical time was significantly shorter in the No group (<i>p</i> = 0.001). The fusion rates were very high for both groups, without difference between groups (<i>p</i> = 1.0). Autografting from the iliac crest (<i>p</i> = 0.001) as well as postoperative immobilisation with a hard collar (<i>p</i> < 0.001) were required in fewer patients in the Ex group. Also, patients in the Ex group were mobilised faster after surgery (<i>p</i> = 0.49). Overall, complication rates were similar between groups, but the Ex group demonstrated fewer major medical complications (16% vs 31%). Male sex and iliac bone harvesting demonstrated significantly higher OR for development of postoperative complications (<i>p</i> = 0.023 and <i>p</i> = 0.034 respectively) and postoperative mobilization demonstrated significant higher OR for development of postoperative major complications (<i>p</i> = 0.042).</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Resection of the C2 nerve root ganglion during posterior instrumented fusion of the cranio-cervical junction is safe and rarely leads to C2 neuropathy. The technique tends to mitigate the odds of developing postoperative complications.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":null,"pages":null},"PeriodicalIF":1.9000,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Safety and efficacy of the new modified technique for c2 nerve root resection in 3d fluoroscopy navigated instrumentation in the cranio-cervical junction\",\"authors\":\"Lukas Bobinski, Linda Sandberg, Frida Bylander, Hampus Hållberg, Anders Berglund, John M. Duff\",\"doi\":\"10.1007/s00701-024-06265-x\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<h3 data-test=\\\"abstract-sub-heading\\\">Purpose</h3><p>Instrumentation of the C1 vertebra requires either mobilization or transection of the C2 nerve root. This study investigates clinical and radiological outcomes and incidences of C2 neuropathic pain after posterior instrumented fusion in the cranio-cervical junction with or without division of the C2 nerve roots.</p><h3 data-test=\\\"abstract-sub-heading\\\">Methods</h3><p>This retrospective study compared two cohorts of patients who underwent instrumented fusion in the cranio-cervical junction. Fifty patients (22 males and 28 females) were operated with complete resection of C2 nerve root ganglion (Ex group), and fifty-one patients (30 men, 21 women) with C2 nerve roots preservation (No group).</p><h3 data-test=\\\"abstract-sub-heading\\\">Results</h3><p>The incidence of postoperative C2 neuropathy was eight times lower in the Ex group compared to the No group that was statistical significant, <i>p</i> = 0.039. Surgical time was significantly shorter in the No group (<i>p</i> = 0.001). The fusion rates were very high for both groups, without difference between groups (<i>p</i> = 1.0). Autografting from the iliac crest (<i>p</i> = 0.001) as well as postoperative immobilisation with a hard collar (<i>p</i> < 0.001) were required in fewer patients in the Ex group. Also, patients in the Ex group were mobilised faster after surgery (<i>p</i> = 0.49). Overall, complication rates were similar between groups, but the Ex group demonstrated fewer major medical complications (16% vs 31%). Male sex and iliac bone harvesting demonstrated significantly higher OR for development of postoperative complications (<i>p</i> = 0.023 and <i>p</i> = 0.034 respectively) and postoperative mobilization demonstrated significant higher OR for development of postoperative major complications (<i>p</i> = 0.042).</p><h3 data-test=\\\"abstract-sub-heading\\\">Conclusions</h3><p>Resection of the C2 nerve root ganglion during posterior instrumented fusion of the cranio-cervical junction is safe and rarely leads to C2 neuropathy. 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Safety and efficacy of the new modified technique for c2 nerve root resection in 3d fluoroscopy navigated instrumentation in the cranio-cervical junction
Purpose
Instrumentation of the C1 vertebra requires either mobilization or transection of the C2 nerve root. This study investigates clinical and radiological outcomes and incidences of C2 neuropathic pain after posterior instrumented fusion in the cranio-cervical junction with or without division of the C2 nerve roots.
Methods
This retrospective study compared two cohorts of patients who underwent instrumented fusion in the cranio-cervical junction. Fifty patients (22 males and 28 females) were operated with complete resection of C2 nerve root ganglion (Ex group), and fifty-one patients (30 men, 21 women) with C2 nerve roots preservation (No group).
Results
The incidence of postoperative C2 neuropathy was eight times lower in the Ex group compared to the No group that was statistical significant, p = 0.039. Surgical time was significantly shorter in the No group (p = 0.001). The fusion rates were very high for both groups, without difference between groups (p = 1.0). Autografting from the iliac crest (p = 0.001) as well as postoperative immobilisation with a hard collar (p < 0.001) were required in fewer patients in the Ex group. Also, patients in the Ex group were mobilised faster after surgery (p = 0.49). Overall, complication rates were similar between groups, but the Ex group demonstrated fewer major medical complications (16% vs 31%). Male sex and iliac bone harvesting demonstrated significantly higher OR for development of postoperative complications (p = 0.023 and p = 0.034 respectively) and postoperative mobilization demonstrated significant higher OR for development of postoperative major complications (p = 0.042).
Conclusions
Resection of the C2 nerve root ganglion during posterior instrumented fusion of the cranio-cervical junction is safe and rarely leads to C2 neuropathy. The technique tends to mitigate the odds of developing postoperative complications.
期刊介绍：
The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.
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