Treatment of Reducible Atlantoaxial Dislocation and Basilar Invagination Using the Head Frame Reduction Technique and Atlantoaxial Arthrodesis

Li, Teng; Du, Yue-Qi; Yin, Yong; Xing, Shao-Ling; Qiao, Guangyu

doi:10.1177/2192568220970164

Cited by 2 publications

(1 citation statement)

References 30 publications

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“…Currently, one of the most common method to treat upper cervical spine injuries and reducible atlantoaxial dislocation is posterior atlantoaxial xation and fusion [3,4] . Surgery is generally applied for atlantoaxial instability to give strong xation, restore sequence, release nerve compression and further atlantoaxial fusion.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical comparison and operation on cadaver of a novel atlantoaxial lateral mass cage

Sun

Wang²,

et al. 2023

Preprint

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Background To improve clinical efficacy of atlantoaxial instability. We design a novel lateral mass cage and compare the biomechanical differences between Pedicle Screw model and Cage + Pedicle Screw model to demonstrate the practicability of the cage. Methods From computed tomography (CT) images, a nonlinear intact three-dimensional C0-3 finite element model was developed. Then a finite element analysis (FEM) of an unstable model treated with Pedicle Screw model, was compared to that with Cage + Pedical Screw model. All models were subjected to vertical load in flexion, extension, lateral bending, rotation, vertical compression and forward shear. Range of motion (ROM) of C1-C2 segment and maximum von Mises Stress of the rod and screws were quantified in two models. Then, we do a simulation operation on cadaver specimen to evaluate the practicability of the mass cage trough photos and CT scan. Results Both two models significantly reduced ROM compared with the unstable model. In comparison with the Pedicle Screw model, the Cage + Pedicle Screw model reduced the ROM by 24.47%, -7.05%, 3.17% and 4.79% in flexion, extension, lateral bending and rotation. The Cage + Pedicle Screw model showed a significant increase stresses on rod and screw than the Pedicle Screw model in flexion, lateral bending, rotation, vertical compression and forward shear. Through the photos and CT scan, the lateral mass cage can be plated into a accurate place. Conclusion Our study indicated that either pedicle screw or cage + pedicle screw can reduce the ROM of C1-C2, while the cage will enhance the stability of C1-C2 in flexion significantly, meanwhile, decrease the stress on the rod and screws.

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Section: Introductionmentioning

confidence: 99%

Biomechanical comparison and operation on cadaver of a novel atlantoaxial lateral mass cage

Sun

Wang²,

et al. 2023

Preprint

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Comparison of robot-assisted versus fluoroscopically guided treatment of atlantoaxial dislocation in combination with high-riding vertebral artery: a preliminary study

Li,

Duan,

Shan

et al. 2024

J Orthop Surg Res

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Background Robotic-assisted surgery has emerged as an innovative approach widely adopted in the field of orthopedics. However, its application specifically for managing atlantoaxial dislocation with a high-riding vertebral artery (AAD-HVA) remains underreported in the existing literature. Objective To compare the perioperative outcomes of robotic-assisted (RA) and fluoroscopic-guided free-hand (FH) techniques for atlantoaxial dislocation in combination with a high-riding vertebral artery (AAD-HVA). Study design This was a retrospective study. Setting This research was performed at a single department of spine surgery. Methods Data from patients who underwent atlantoaxial internal fixation between July 2018 and January 2022 at our hospital were retrospectively analyzed. Among the cases, 14 were performed using free-hand (FH) techniques and 11 utilized robotic-assisted (RA) techniques. Data collected included case notes, imaging records, and follow-up data. The reliability of screw placement was evaluated based on the Gertzbein and Robbins scores, while treatment outcomes were assessed using the Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS), neck disability index (NDI), and postoperative complication rate. Results Baseline patient characteristics were comparable between the FH and RA groups. The mean blood loss was markedly lower in the RA group (157.3 ± 49.7 ml) compared to the FH group (290.0 ± 110.3 ml) ( p = 0.03). Although the average operative time was slightly higher in FH group than in RA group, this disparity did not achieve statistical significance ( p = 0.7588). Moreover, the radiation exposure dose was remarkably higher in FH group (32.7 ± 4.4 mGy) than in RA group (23.0 ± 3.2 mGy) ( p < 0.0001). The percentage of clinically acceptable screw placement was slightly lower in FH group (87.5%) than in RA group (97.8%), but the observed variance was not statistically meaningful ( p = 0.3669). Furthermore, the differences in JOA, VAS, and NDI scores between the FH and RA groups were not statistically significant. Additionally, no obvious differences were found in clinical outcomes or complications related to screw implantation between the two groups. Limitations This study has inherent limitations as it was retrospective in nature and conducted at a single center. Conclusion Robotic-assisted surgery for AAD-HVA patients offers a minimally invasive approach, reduced bleeding and lower radiation exposure compared with traditional free-hand surgery.

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Treatment of Reducible Atlantoaxial Dislocation and Basilar Invagination Using the Head Frame Reduction Technique and Atlantoaxial Arthrodesis

Cited by 2 publications

References 30 publications

Biomechanical comparison and operation on cadaver of a novel atlantoaxial lateral mass cage

Biomechanical comparison and operation on cadaver of a novel atlantoaxial lateral mass cage

Comparison of robot-assisted versus fluoroscopically guided treatment of atlantoaxial dislocation in combination with high-riding vertebral artery: a preliminary study

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