Complications of occipitocervical fixation: retrospective review of 128 patients with 5-year mean follow-up

Zılelı, Mehmet; Akıntürk, Nevhis

doi:10.1007/s00586-021-07037-2

Cited by 25 publications

(20 citation statements)

References 30 publications

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“…3 Moreover, the anatomical morphology of cervical vertebrae is complicated by alterations due to the cervical fractures and congenital malformation, increasing the difficulty of cervical screw insertions. 4,5 Correspondingly, surgeons require years to gain sufficient experience to safely complete cervical screw instrumentation. Therefore, the demands for safety and accuracy of cervical screw placement drive advance in robot-assisted (RA) techniques on cervical spine surgery.…”

Section: Neurospine Eissn 2586-6591 Pissn 2586-6583mentioning

confidence: 99%

Robotics in Cervical Spine Surgery: Feasibility and Safety of Posterior Screw Placement

Zhou

Zhang

et al. 2023

Neurospine

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Objective: Robot-assisted (RA) techniques have been widely investigated in thoracolumbar spine surgery. However, the application of RA methods on cervical spine surgery is rare due to the complex morphology of cervical vertebrae and catastrophic complications. Thus, the feasibility and safety of RA cervical screw placement remain controversial. This study aims to evaluate the feasibility and safety of RA screw placement on cervical spine surgery.Methods: A comprehensive search on PubMed, Cochrane Library, Embase Database, Web of Science, Chinese National Knowledge Databases, and Wanfang Database was performed to select potential eligible studies. Randomized controlled trials (RCTs), comparative cohort studies, and case series reporting the accuracy of cervical screw placement were included. The Cochrane risk of bias criteria and Newcastle-Ottawa Scale criteria were utilized to rate the risk of bias of the included literatures. The primary outcome was the rate of cervical screw placement accuracy with robotic guidance; subgroup analyses based on the screw type and insertion segments were also performed.Results: One RCT, 3 comparative cohort studies, and 3 case series consisting of 160 patients and 719 cervical screws were included in this meta-analysis. The combined outcomes indicated that the rates of optimal and clinically acceptable cervical screw placement accuracy under robotic guidance were 88.0% (95% confidence interval [CI], 84.1%–91.4%; p = 0.073; I2 = 47.941%) and 98.4% (95% CI, 96.8%–99.5%; p = 0.167; I2 = 35.954%). The subgroup analyses showed that the rate of optimal pedicle screw placement accuracy was 88.2% (95% CI, 83.1%–92.6%; p = 0.057; I2 = 53.305%); the rates of optimal screw placement accuracy on C1, C2, and subaxial segments were 96.2% (95% CI, 80.5%–100.0%; p = 0.167; I2 = 44.134X%), 89.7% (95% CI, 80.6%–96.6%; p = 0.370; I2 = 0.000X%), and 82.6% (95% CI, 70.9%–91.9%; p = 0.057; I2 = 65.127X%;), respectively.Conclusion: RA techniques were associated with high rates of optimal and clinically acceptable screw positions. RA cervical screw placement is accurate, safe, and feasible in cervical spine surgery with promising clinical potential.

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Section: Neurospine Eissn 2586-6591 Pissn 2586-6583mentioning

confidence: 99%

Robotics in Cervical Spine Surgery: Feasibility and Safety of Posterior Screw Placement

Zhou

Zhang

et al. 2023

Neurospine

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“…Furthermore, it provides the most direct route to osseous and soft-tissue abnormalities that are ventral to the brainstem and therefore it provides the shortest working distance for lesion treatment. The transoral approach can be used for the surgical treatment of various diseases, including congenital or secondary malformation (basilar invagination [ 7 – 9 ], atlas assimilation [ 10 , 11 ], os odontoideum [ 12 ], atlantoaxial fixed dislocation [ 13 ]), trauma [ 14 ], tumor [ 15 ], spondylotic [ 16 ], autoimmune (most frequently rheumatoid arthritis [ 17 , 18 ]), chronic inflammatory diseases [ 19 ], and osteomyelitis [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Research on pharyngeal bacterial flora in transoral atlantoaxial operation and the postoperative follow-up study

You

Zhou

et al. 2022

BMC Musculoskelet Disord

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Objectives To study the changes of bacterial flora after a series of preoperative oral disinfection and the postoperative recovery of nerve function of patients with craniovertebral junction disorders who were treated with transoral approach operations. Methods This research analyzed 20 cases collected from October 2009 to May 2010. All these patients were with CVJ disorders, including 8 males and 12 females, aged 2 to 66 (38.1 on average), and they were all treated with transoral approach operations. The mucosa samples of the posterior pharyngeal wall were sent for bacteria culture. These samples were collected by sterile cotton swabs at four crucial points, including 3 days before operation/before gargling, 3 days after continuous gargling/after anesthesia intubation on the day of operation, after intraoperative cleaning and washing of the mouth, and after intraoperative iodophor immersion. The microflora was stained by means of smear and further counted after an investigation by microscope. The neural function of patients was evaluated by the ASIA classification and the JOA scores. All patients but two with posterior stabilization performed respectively underwent transoral atlantoaxial reduction plate (TARP) fixation consecutively in the same sitting. A regular reexamination of cervical vertebra with lateral and open mouth X-ray, CT and MRI was conducted after operation to evaluate the reduction of atlantoaxial dislocation, internal fixation position, bone graft fusion, inflammatory lesions and tumor recurrence. Results This bacteriological research showed that the mucosa of the posterior pharyngeal wall of all the patients was in a sterile state after a series of oral preoperative preparations and intraoperative iodophor disinfection, which was considered as type I incision. The bacterial culture results of the mucosa samples of the posterior pharyngeal wall collected at different time points showed significant differences (χ2 = 42.762, P = 0.000). All the patients had improvement in ASIA, and their neural functions were improved to different levels after operation. There was a significant difference in JOA scores before and after operation (t = 8.677, P = 0.000). Postoperative imaging examination showed that the atlantoaxial screw position was good and firm, and the CVJ disorders were treated appropriately. Conclusion It is safe and effective to cut the posterior pharyngeal muscle layer and implant internal fixation by means of transoral approach.

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“…The treatment of SSI in the presence of an instrument is rendered extremely challenging by the presence of biofilms, which could interfere with the effect of antibiotics 15. Although the combination of antibiotics and repeated radical debridement has been the gold standard of treatment for SSI after spinal instrumentation surgeries,16 23% to 66% of patients may require implant removal 17–19. In such scenarios, implant removal can result in pseudarthrosis and loss of correction, which are related to poor clinical outcomes 20…”

mentioning

confidence: 99%

Incidence of surgical site infection following lateral lumbar interbody fusion compared with posterior/transforminal lumbar interbody fusion: A propensity score-weighted study

Masuda

Fukasawa

Takeuchi

et al. 2023

Spine

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Study Design. Retrospective cohort study.Objective. The objective of this study was to compare the incidence of surgical site infection (SSI) after lateral lumbar interbody fusion (LLIF) and posterior/transforaminal lumbar interbody fusion (P/TLIF). Summary of Background Data. Previous studies have shown that LLIF can improve neurological symptoms to a comparable degree to P/TLIF. However, data on the risk of SSI after LLIF is lacking compared with P/TLIF. Materials and Methods. The study was conducted under a retrospective cohort design in patients undergoing LLIF or P/TLIF for lumbar degenerative diseases between 2013 and 2020 using a hospital administrative database. We used propensity score overlap weighting to adjust for confounding factors including age, sex, body mass index, comorbidities, number of fusion levels, hospital size, and surgery year. We estimated weighted odds ratios (ORs) and 95% CIs for SSI within 30 days postoperatively. Results. We compared the risk of SSI between 2874 patients who underwent LLIF and 24,245 patients who received P/TLIF Patients who had received LLIF were at significantly less risk of experiencing an SSI compared with those receiving P/TLIF (0.7% vs. 1.2%; weighted OR: 0.57; 95% CI: 0.36 -0.92; P = 0.02). As a secondary outcome, patients who had received LLIF had less risk of transfusion (7.8% vs. 11.8%; weighted OR: 0.63; 95% CI:0.54 -0.73; P < 0.001). Conclusions. In this large retrospective cohort study of adults undergoing lumbar interbody fusion, LLIF was associated with a significantly lower risk of SSI than P/TLIF. The small, but significantly, decreased risk of SSI associated with LLIF may inform decisions regarding the technical approach for lumbar interbody fusion.

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Complications of occipitocervical fixation: retrospective review of 128 patients with 5-year mean follow-up

Cited by 25 publications

References 30 publications

Robotics in Cervical Spine Surgery: Feasibility and Safety of Posterior Screw Placement

Robotics in Cervical Spine Surgery: Feasibility and Safety of Posterior Screw Placement

Research on pharyngeal bacterial flora in transoral atlantoaxial operation and the postoperative follow-up study

Incidence of surgical site infection following lateral lumbar interbody fusion compared with posterior/transforminal lumbar interbody fusion: A propensity score-weighted study

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