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| YAO Nüzhao,WANG Wenjun,WANG Lushan.Endoscopy-assisted anterior transarticular screw fixation and bone grafting for upper cervical instability[J].Chinese Journal of Spine and Spinal Cord,2012,(4):292-296. |
| Endoscopy-assisted anterior transarticular screw fixation and bone grafting for upper cervical instability |
| Received:December 27, 2011 Revised:January 17, 2012 |
| English Keywords:Upper cervical instability Transarticular screw fixation Spinal fusion Endoscopy Minimal invasive |
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| English Abstract: |
| 【Abstract】 Objectives: To evaluate the operation method and clinical outcome of atlantoaxial joint fusion using endoscopy-assisted anterior transarticular screw fixation and bone grafting for upper cervical instability. Methods: 13 cases with upper cervical instability who underwent anterior release with endoscopic aide and subsequently reduction, anterior transarticular screw fixation and morselized autologous bone grafts from January 2006 to December 2009 were retrospectively analyzed． There were 8 males and 5 females, with an average age of 46.8 years(range 17-65 years). There were 6 cases of Jefferson fracture(type Ⅱ), 1 case of fracture of C1 anterior arch(type Ⅲ), 3 cases of atlantoaxial joint dislocation, 3 cases of chronic odontoid fracture. All patients showed neck pain and activity limitation. The preoperative visual analogue scale(VAS) scores of neck pain were 3.2 to 4.1(average 3.8). According to the Frankel classifiaction of disability, 1 case was grade C and 1 case grade D. Evaluation parameters included VAS scores of neck pain, neurological function and bony fusion. Results: All patients were performed successfully by endoscopy-assisted anterior tansarticular screw fixation and bone grafting. 26 screws were implanted in 13 cases. The average operation time was 80min(range, 60 to 130min), and the mean estimated blood loss was 190ml(range, 110 to 290ml). No patient had the injury of spinal cord and vertebral artery. According to the postoperative computed tomography, 25 screws were appropriately placed except that a part of one screw was implant into spinal canal but without neurological deficit. All cases restored anatomic position and stability. The patients were all followed up for an average of 18 months(12-60 months). The average VAS was 1.3(1.0-2.0) at final follow-up. There was significant difference in VAS between preoperation and postoperation(P＜0.05). Neurological functions improved by one grade in both 2 patients according to Frankel grading criteria． All cases occurred bone fusion at 3 months postoperatively and got bony fusion at final follow-up except 1 case. Postoperative final follow-up radiographs demonstrated that all cases almost restored to anatomic position. There was no screw failure complication. Conclusions: Endoscopy-assisted anterior transarticular screw fixation and bone grafting can achieve satisfactory clinical outcomes in patients with instability of the upper cervical spine． This operation procedure for upper cervical instability has the advantage of simplicity, less trauma and minimized bleeding. |
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