Minimally invasive percutaneous screw fixation of traumatic spondylolisthesis of the axis

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Most cases of traumatic spondylolisthesis of the axis (hangman's fracture) can be treated nonoperatively with reduction and subsequent immobilization in a rigid cervical collar or halo. However, in some instances, operative management is necessary and can be accomplished by using either anterior or posterior fusion techniques. Because open posterior procedures can result in significant blood loss, pain, and limited cervical range of motion, other less invasive options for posterior fixation are needed. The authors describe a minimally invasive, navigation-guided technique for surgical treatment of Levine-Edwards (L-E) Type II hangman's fractures.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>For 5 patients with L-E Type II hangman's fracture requiring operative reduction and internal fixation, percutaneous screw fixation directed through the fracture site was performed. This technique was facilitated by use of intraoperative 3D fluoroscopy and neuronavigation.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Of the 5 patients, 2 were women, 3 were men, and age range was 46–67 years. No intraoperative or postoperative complications occurred. All patients wore a rigid cervical collar, and flexion-extension radiographs were obtained at 6 months. For all patients, dynamic imaging demonstrated a stable construct.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>L-E type II hangman's fractures can be safely repaired by using percutaneous minimally invasive surgical techniques. This technique may be appropriate, depending on circumstances, for all L-E Type I and II hangman's fractures; however, the degree of associated ligament injury and disc disruption must be accounted for. Percutaneous fixation is not appropriate for L-E Type III fractures because of significant displacement and ligament and disc disruption. This report is meant to serve as a feasibility study and is not meant to show superiority of this procedure over other surgical options.</jats:p></jats:sec>

Minimally invasive scoliosis surgery assisted by O-arm navigation for Lenke Type 5C adolescent idiopathic scoliosis: a comparison with standard open approach spinal instrumentation

“…Traditional minimally invasive pedicle screw placement was performed via a percutaneous procedure. 3,6,12 Percutaneous pedicle screw placement with a stab incision not only creates immense cosmetic problems, but also limits adequate facetectomy and fusion, which is not preferable in AIS correction surgery. In our study, 2 limited incisions (3-5 cm) were used.…”

Fractures of the axis: a review of pediatric, adult, and geriatric injuries

“…Lag screw fixation through the fracture fragments has also been described for type II injuries. This technique neglects the C2-C3 discoligamentous injury, however, and significant displacement through the C2-C3 disc may preclude lag screw management [46]. Muller et al emphasized the importance of the C2-C3 disc integrity, noting that nonoperative management was most likely to fail in these patients, with nearly half of those patients undergoing a delayed surgery [37].…”

Direct C2 Pedicle Screw Fixation for Axis Body Fracture

“…24 Fluoroscopy alone is likely sufficient for surgeons who are very familiar with the anatomy of the C2 vertebra, but Iso-C3D has been shown to assist with optimal screw placement. [25][26][27] We used stereotactic navigation with O-arm CT and the Stealth Station system for each procedure and found it to be useful for planning and placement of screws.…”