Skip to main content

Advertisement

SpringerLink
Log in

Atlantoaxial posterior screw fixation using intra-operative spinal navigation with three-dimensional isocentric C-arm fluoroscopy

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Intra-operative image acquisition coupled with navigation aims to increase screw placement accuracy, and it is particularly helpful in complex spinal procedures. The aim of this study is to analyze the accuracy and reliability of posterior atlanto-axial fixation using spinal navigation combined with intra-operative 3D isocentric C-arm.

Methods

We retrospectively reviewed all patients presenting with C1–C2 instability and treated by posterior atlanto-axial fixation in our center between December 2016 and September 2018. Screw positioning was guided by intra-operative navigation, registered with surface matching procedure on a previously obtained CT scan and controlled by intra-operative 3D isocentric C-arm. Age, sex, pre- and post-operative neurological status, duration of surgery, presence/absence of vertebral artery injury, and screw placement were retrospectively collected from patients’ records. All patients underwent clinical and radiological follow-up at three months after surgery. Radiological assessment of screw positioning was performed by an independent radiologist using the Gertzbein and Robbins grading.

Results

N = 11 (7F, 4 M) consecutive patients were included, with a mean age of 72 years (range from 51 to 85). N = 44 navigated screws were inserted and controlled with intra-operative 3D fluoroscopy at the end of the procedure. An acceptable screw positioning (Gertzbein-Robbins grade A and B) was obtained in all cases (100%). No vertebral artery injury was observed. Mean operating time was 123 minutes. At three months, no screw loosening or displacement was observed.

Conclusion

In our experience, spinal navigation coupled with intra-operative 3D fluoroscopy proved to be reliable and safe for C1–C2 screw placement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

Patients’ data are anonymized, stored, and protected by password on Geneva University Hospitals Medical Database. Patients’ data are inserted in the database under authors’ responsibility.

Code availability

Custom Code is protected and retained by all authors.

Abbreviations

VA:

Vertebral artery

CT:

Computed tomography

CTA:

CT angiography

MRI:

Magnetic resonance imaging

References

  1. Goel A (2015) Craniovertebral junction instability: a review of facts about facets. Asian Spine J. https://doi.org/10.4184/asj.2015.9.4.636

  2. Ciappetta P, Alsagheir M, Signorelli F, Visocchi M (2019) Posttraumatic anatomical injuries of the craniovertebral junction and treatment implications: Part I. Acta Neurochirurgica, Supplementum. https://doi.org/10.1007/978-3-319-62515-7_42

  3. Dagtekin A, Avci E, Hamzaoglu V et al (2018) Management of occipitocervical junction and upper cervical trauma. J Craniovertebr Junction Spine. https://doi.org/10.4103/jcvjs.JCVJS_72_18

    Article  PubMed  PubMed Central  Google Scholar 

  4. Molliqaj G, Dammann P, Schaller K et al (2019) Management of craniovertebral junction tuberculosis presenting with atlantoaxial dislocation. Acta Neurochir Suppl

  5. Lacy J, Bajaj J, Gillis C Atlantoaxial instability. In: StatPearls Publ. https://www.ncbi.nlm.nih.gov/books/NBK519563/%0A. Accessed 10 Jul 2020

  6. Jeanneret B, Magerl F (1992) Primary posterior fusion C1/2 in odontoid fractures: indications, technique, and results of transarticular screw fixation. J Spinal Disord. https://doi.org/10.1097/00002517-199212000-00012

    Article  PubMed  Google Scholar 

  7. Harms J, Melcher RP (2001) Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine. https://doi.org/10.1097/00007632-200111150-00014

  8. Wright NM, Lauryssen C (1998) Vertebral artery injury in C1–2 transarticular screw fixation: results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves. J Neurosurg. https://doi.org/10.3171/jns.1998.88.4.0634

    Article  PubMed  Google Scholar 

  9. Bredow J, Oppermann J, Kraus B et al (2015) The accuracy of 3D fluoroscopy-navigated screw insertion in the upper and subaxial cervical spine. Eur Spine J. https://doi.org/10.1007/s00586-015-3974-2

    Article  PubMed  Google Scholar 

  10. Czabanka M, Haemmerli J, Hecht N et al (2017) Spinal navigation for posterior instrumentation of C1–2 instability using a mobile intraoperative CT scanner. J Neurosurg Spine. https://doi.org/10.3171/2017.1.SPINE16859

    Article  PubMed  Google Scholar 

  11. Smith JD, Jack MM, Harn NR et al (2016) Screw placement accuracy and outcomes following o-Arm-navigated atlantoaxial fusion:a feasibility study. Glob Spine J. https://doi.org/10.1055/s-0035-1563723

    Article  Google Scholar 

  12. Narain AS, Hijji FY, Yom KH et al (2017) Radiation exposure and reduction in the operating room: perspectives and future directions in spine surgery. World J Orthop. https://doi.org/10.5312/wjo.v8.i7.524

  13. Gertzbein S, Robbins S (1990) Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976). https://doi.org/10.1097/00007632-199001000-00004

  14. Payer M, Luzi M, Tessitore E (2009) Posterior atlanto-axial fixation with polyaxial C1 lateral mass screws and C2 pars screws. Acta Neurochir (Wien). https://doi.org/10.1007/s00701-009-0198-4

    Article  Google Scholar 

  15. Tessitore E, Bartoli A, Schaller K, Payer M (2011) Accuracy of freehand fluoroscopy-guided placement of C1 lateral mass and C2 isthmic screws in atlanto-axial instability. Acta Neurochir (Wien). https://doi.org/10.1007/s00701-011-1039-9

    Article  Google Scholar 

  16. Jacobs C, Roessler PP, Scheidt S et al (2017) When does intraoperative 3D-imaging play a role in transpedicular C2 screw placement? Injury. https://doi.org/10.1016/j.injury.2017.09.008

    Article  PubMed  Google Scholar 

  17. Yeom JS, Buchowski JM, Kim HJ et al (2013) Risk of vertebral artery injury: comparison between C1–C2 transarticular and C2 pedicle screws. Spine J. https://doi.org/10.1016/j.spinee.2013.04.005

    Article  PubMed  Google Scholar 

  18. Elliott RE, Tanweer O, Boah A et al (2012) Comparison of safety and stability of C-2 pars and pedicle screws for atlantoaxial fusion: meta-analysis and review of the literature: a systematic review. J. Neurosurg Spine. https://doi.org/10.3171/2012.9.SPINE111021

  19. Cyr SJ, Currier BL, Eck JC et al (2008) Fixation strength of unicortical versus bicortical C1–C2 transarticular screws. Spine J. https://doi.org/10.1016/j.spinee.2007.02.008

    Article  PubMed  Google Scholar 

  20. Eck JC, Walker MP, Currier BL et al (2007) Biomechanical comparison of unicortical versus bicortical C1 lateral mass screw fixation. J Spinal Disord Tech. https://doi.org/10.1097/BSD.0b013e318031af8b

    Article  PubMed  Google Scholar 

  21. Mummaneni PV, Haid RW (2005) Atlantoaxial fixation: overview of all techniques. Neurol India 53:408–415. https://doi.org/10.4103/0028-3886.22606

    Article  PubMed  Google Scholar 

  22. Stillerman CB, Wilson JA (1993) Atlanto-axial stabilization with posterior transarticular screw fixation. Neurosurgery 32:948–955. https://doi.org/10.1227/00006123-199306000-00011

    Article  CAS  PubMed  Google Scholar 

  23. Yang Y, Wang F, Han S et al (2015) Isocentric C-arm three-dimensional navigation versus conventional C-arm assisted C1–C2 transarticular screw fixation for atlantoaxial instability. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-015-2249-z

    Article  PubMed  Google Scholar 

  24. Yang YL, Zhou DS, He JL (2013) Comparison of isocentric C-arm 3-dimensional navigation and conventional fluoroscopy for C1 lateral mass and C2 pedicle screw placement for atlantoaxial instability. J Spinal Disord Tech. https://doi.org/10.1097/BSD.0b013e31823d36b6

    Article  PubMed  Google Scholar 

  25. Hitti FL, Hudgins ED, Chen HI et al (2017) Intraoperative navigation is associated with reduced blood loss during C1–C2 posterior cervical fixation. World Neurosurg 107:574–578. https://doi.org/10.1016/j.wneu.2017.08.051

    Article  PubMed  Google Scholar 

  26. Hur J-W, Kim J-S, Ryu K-S, Shin M-H (2019) Accuracy and safety in screw placement in the high cervical spine. Clin Spine Surg. https://doi.org/10.1097/bsd.0000000000000813

    Article  PubMed  Google Scholar 

  27. Ryu JI, Bak KH, Kim JM, Chun HJ (2017) Comparison of transarticular screw fixation and C1 lateral mass-C2 pedicle screw fixation in patients with rheumatoid arthritis with atlantoaxial instability. World Neurosurg. https://doi.org/10.1016/j.wneu.2016.12.028

    Article  PubMed  Google Scholar 

  28. Maugeri R, Iacopino DG, Giammalva GR et al (2019) Learning curve in surgical treatment of odontoid fixation for a series of type II C2 fractures. Acta Neurochirurgica, Supplementum. https://doi.org/10.1007/978-3-319-62515-7_47

Download references

Author information

Author notes

  1. Gianpaolo Jannelli and Alessandro Moiraghi contributed equally to this work.

Authors and Affiliations

  1. Division of Neurosurgery, Geneva University Hospitals and University of Geneva Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland

    Gianpaolo Jannelli, Alessandro Moiraghi, Luca Paun, Andrea Bartoli & Enrico Tessitore

  2. Department of Neurosurgery, GHU Paris—Sainte-Anne Hospital, Université de Paris, Paris, France

    Alessandro Moiraghi

  3. Inserm, U1266, IMA-Brain, Institut de Psychiatrie Et Neurosciences de Paris, Paris, France

    Alessandro Moiraghi

  4. Institut d’Imagerie Médicale, Geneva, Switzerland

    Victor Cuvinciuc

Authors
  1. Gianpaolo Jannelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alessandro Moiraghi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luca Paun
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Victor Cuvinciuc
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrea Bartoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Enrico Tessitore
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

GJ: project draft, data extraction/analysis, and manuscript writing; AM: data extraction/analysis and manuscript writing; LP: data analysis and manuscript writing; VC radiological data analysis and critical revision of the manuscript; AB: manuscript writing and critical revision of the manuscript; ET: project draft, data analysis, manuscript writing, overall project supervision.

Corresponding author

Correspondence to Luca Paun.

Ethics declarations

Ethics approval

The study protocol was approved by the local Ethical Committee (Project ID 2019-00791). 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.

Consent to participate and for publication

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

Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

Conflict of interest

Enrico Tessitore: Training fees from: Spineart, Medtronic, Depuy Synthes, Nuvasive.

Other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jannelli, G., Moiraghi, A., Paun, L. et al. Atlantoaxial posterior screw fixation using intra-operative spinal navigation with three-dimensional isocentric C-arm fluoroscopy. International Orthopaedics (SICOT) 46, 321–329 (2022). https://doi.org/10.1007/s00264-021-05276-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-021-05276-y

Keywords

Search

Navigation