Advertisement

X-ray exposure in odontoid screwing for Anderson type II fracture: comparison between O-arm and C-arm-assisted procedures

  • Luca RicciardiEmail author
  • Nicola Montano
  • Ginevra Federica D’Onofrio
  • Filippo Maria Polli
  • Marco Latini
  • Alessandro Bellesi
  • Fabio Biovi
  • Alessandro Olivi
  • Carmelo Lucio Sturiale
Technical Note - Spine trauma
  • 26 Downloads
Part of the following topical collections:
  1. Spine trauma

Abstract

Background

Since the odontoid fractures become increasingly common in the aging population, technical improvements are even more needed. The odontoid screwing has been progressively preferred by many surgeons in type II fractures according to the Anderson-D’Alonzo classification system. However, X-ray exposure remains an issue for surgeons and OR staff members. The aim of the present study was to investigate the feasibility of using the O-Arm for odontoid screwing comparing the radiation exposure to the standard C-Arm.

Methods

Patients consequently referred to our center for odontoid type II fractures, from January 2018 to April 2019, eligible for odontoid screwing were enrolled in the present study. They were operated on using either C-Arm or O-Arm-assisted procedures. The surgical duration, number of acquisitions, global X-ray exposure for the OR staff and patients, and screw placement accuracy were evaluated.

Results

No differences in terms of patients’ demographical characteristics and surgical duration were reported. The number of acquisitions, intraoperative and global X-ray dose, for the OR staff and patients, was lower in O-Arm-assisted procedures (p < 0.05). The screws were all well positioned.

Conclusions

Since the surgical outcomes seem to be similar using the O-Arm for odontoid screwing, the lower X-ray exposure and the possibility for checking the instrumentation positioning with 3D reconstructions before leaving the OR should be considered.

Keywords

Odontoid screwing CVJ X-ray exposure Patient’s safety Minimally invasive spine surgery Intraoperative imaging 

Abbreviations

ACDS

Anterior cervical approach for dens screwing

AP

Antero-posterior

CVJ

Cranio-vertebral junction

LL

Latero-lateral

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Anderson LD, D’Alonzo RT (1974) Fractures of the odontoid process of the axis. J Bone Joint Surg Am 56(8):1663–1674CrossRefGoogle Scholar
  2. 2.
    Böhler J (1982) Anterior stabilization for acute fractures and non-unions of the dens. J Bone Joint Surg Am 64(1):18–27CrossRefGoogle Scholar
  3. 3.
    Curzio G, Grillmaier RE, O’Sullivan D, Pelliccioni M, Piermattei S, Tommasino L (2001) The Italian national survey of aircrew exposure: II. On-board measurements and results. Radiat Prot Dosimetry 93(2):125–133CrossRefGoogle Scholar
  4. 4.
    Dabaghi Richerand A, Christodoulou E, Li Y, Caird MS, Jong N, Farley FA (2016) Comparison of effective dose of radiation during pedicle screw placement using intraoperative computed tomography navigation versus fluoroscopy in children with spinal deformities. J Pediatr Orthop 36(5):530–533CrossRefGoogle Scholar
  5. 5.
    De Bonis P, Iaccarino C, Musio A et al (2019) Functional outcome of elderly patients treated for odontoid fracture: a multicenter study. Spine.  https://doi.org/10.1097/BRS.0000000000002982 CrossRefGoogle Scholar
  6. 6.
    Della Pepa GM, Mattogno PP, La Rocca G, Sabatino G, Olivi A, Ricciardi L, Polli FM (2018) Real-time intraoperative contrast-enhanced ultrasound (CEUS) in vascularized spinal tumors: a technical note. Acta Neurochir (Wien).  https://doi.org/10.1007/s00701-018-3541-9 CrossRefGoogle Scholar
  7. 7.
    Du JP, Fan Y, Wu QN, Wang DH, Zhang J, Hao DJ (2018) Accuracy of pedicle screw insertion among 3 image-guided navigation systems: systematic review and meta-analysis. World Neurosurg 109:24–30CrossRefGoogle Scholar
  8. 8.
    Hadley MN, Walters BC, Grabb PA, Oyesiku NM, Przybylski GJ, Resnick DK, Ryken TC, Mielke DH (2002) Guidelines for the management of acute cervical spine and spinal cord injuries. Clin Neurosurg 49:407–498PubMedGoogle Scholar
  9. 9.
    Iyer S, Hurlbert RJ, Albert TJ (2018) Management of odontoid fractures in the elderly: a review of the literature and an evidence-based treatment algorithm. Neurosurgery 82(4):419–430CrossRefGoogle Scholar
  10. 10.
    Joaquim AF, Patel AA (2015) Surgical treatment of type II odontoid fractures: anterior odontoid screw fixation or posterior cervical instrumented fusion? Neurosurg Focus 38(4):E11CrossRefGoogle Scholar
  11. 11.
    Khattab MF, Nageeb Mahmoud A, Saeed Younis A, El-Hawary Y (2019) A simple technique for easier anterior odontoid screw fixation. Br J Neurosurg 33(2):135–139CrossRefGoogle Scholar
  12. 12.
    La Rocca G, Altieri R, Ricciardi L, Olivi A, Della Pepa GM (2017) Anatomical study of occipital triangles: the “inferior” suboccipital triangle, a useful vertebral artery landmark for safe postero-lateral skull base surgery. Acta Neurochir (Wien) 159(10):1887–1891CrossRefGoogle Scholar
  13. 13.
    Larson AN, Schueler BA, Dubousset J (2019) Radiation in spine deformity: state-of-the-art reviews. Spine Deform 7(3):386–394CrossRefGoogle Scholar
  14. 14.
    Lauretti L, D’Alessandris QG, Rigante M, Ricciardi L, Mattogno PP, Olivi A (2018) O-arm in endonasal endoscopic cranial base surgery: technical note on initial feasibility. World Neurosurg 117:103–108CrossRefGoogle Scholar
  15. 15.
    Lofrese G, Musio A, De Iure F et al (2019) Type II odontoid fracture in elderly patients treated conservatively: is fracture healing the goal? Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc.  https://doi.org/10.1007/s00586-019-05898-2 CrossRefGoogle Scholar
  16. 16.
    Mendelsohn D, Strelzow J, Dea N et al (2016) Patient and surgeon radiation exposure during spinal instrumentation using intraoperative computed tomography-based navigation. Spine J Off J North Am Spine Soc 16(3):343–354CrossRefGoogle Scholar
  17. 17.
    Overley SC, Cho SK, Mehta AI, Arnold PM (2017) Navigation and robotics in spinal surgery: where are we now? Neurosurgery 80(3S):S86–S99CrossRefGoogle Scholar
  18. 18.
    Pijpker PAJ, Kuijlen JMA, Kraeima J, Faber C (2018) Three-dimensional planning and use of individualized osteotomy-guiding templates for surgical correction of kyphoscoliosis: a technical case report. World Neurosurg 119:113–117CrossRefGoogle Scholar
  19. 19.
    Pisapia JM, Nayak NR, Salinas RD, Macyszyn L, Lee JYK, Lucas TH, Malhotra NR, Isaac Chen H, Schuster JM (2017) Navigated odontoid screw placement using the O-arm: technical note and case series. J Neurosurg Spine 26(1):10–18CrossRefGoogle Scholar
  20. 20.
    Polli FM, Miscusi M, Forcato S, Raco A (2015) Atlantoaxial anterior transarticular screw fixation: a case series and reappraisal of the technique. Spine J Off J North Am Spine Soc 15(1):185–193CrossRefGoogle Scholar
  21. 21.
    Ricciardi L, Chaichana KL, Cardia A, Stifano V, Rossini Z, Olivi A, Sturiale CL (2019) The exoscope in neurosurgery: an innovative “point of view”. A systematic review of the technical, surgical and educational aspects. World Neurosurg.  https://doi.org/10.1016/j.wneu.2018.12.202 CrossRefGoogle Scholar
  22. 22.
    Ricciardi L, Sturiale CL, Izzo A et al (2019) Submandibular approach for single-stage craniovertebral junction ventral decompression and stabilization: a preliminary cadaveric study of technical feasibility. World Neurosurg.  https://doi.org/10.1016/j.wneu.2019.04.038 CrossRefGoogle Scholar
  23. 23.
    Riis J, Lehman RR, Perera RA, Quinn JR, Rinehart P, Tuten HR, Kuester V (2017) A retrospective comparison of intraoperative CT and fluoroscopy evaluating radiation exposure in posterior spinal fusions for scoliosis. Patient Saf Surg 11:32CrossRefGoogle Scholar
  24. 24.
    Schroeder GD, Kepler CK, Kurd MF, Paul JT, Rubenstein RN, Harrop JS, Brodke DS, Chapman JR, Vaccaro AR (2015) A systematic review of the treatment of geriatric type II odontoid fractures. Neurosurgery 77(Suppl 4):S6–S14CrossRefGoogle Scholar
  25. 25.
    Shin BJ, James AR, Njoku IU, Härtl R (2012) Pedicle screw navigation: a systematic review and meta-analysis of perforation risk for computer-navigated versus freehand insertion. J Neurosurg Spine 17(2):113–122CrossRefGoogle Scholar
  26. 26.
    Yang YL, Fu BS, Li RW, Smith PN, Mu WD, Li LX, Zhou DS (2011) Anterior single screw fixation of odontoid fracture with intraoperative Iso-C 3-dimensional imaging. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 20(11):1899–1907CrossRefGoogle Scholar
  27. 27.
    Yu E, Khan SN (2014) Does less invasive spine surgery result in increased radiation exposure? A systematic review. Clin Orthop 472(6):1738–1748CrossRefGoogle Scholar
  28. 28.
    Yuan S, Wei B, Tian Y, Yan J, Xu W, Wang L, Liu X (2018) The comparison of clinical outcome of fresh type II odontoid fracture treatment between anterior cannulated screws fixation and posterior instrumentation of C1-2 without fusion: a retrospective cohort study. J Orthop Surg 13(1):3CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Luca Ricciardi
    • 1
    • 2
    Email author
  • Nicola Montano
    • 1
  • Ginevra Federica D’Onofrio
    • 1
    • 2
  • Filippo Maria Polli
    • 1
  • Marco Latini
    • 3
  • Alessandro Bellesi
    • 3
  • Fabio Biovi
    • 3
  • Alessandro Olivi
    • 1
    • 2
  • Carmelo Lucio Sturiale
    • 1
  1. 1.UOC di NeurochirurgiaFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
  2. 2.Istituto di NeurochirurgiaUniversità Cattolica del Sacro CuoreRomeItaly
  3. 3.Dipartimento di RadiodiagnosticaFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly

Personalised recommendations