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Minimally invasive instrumentation of uncomplicated cervical fractures

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Abstract

Purpose

Many authors favor conservative treatment options in oligo-symptomatic non-dislocated cervical fractures. This is mainly because of adverse events, anesthesia times and blood loss associated with surgical treatment of these injuries. We, therefore, sought to minimize the invasiveness of the surgical treatment of simple cervical fractures using image-guidance and a percutaneous approach.

Methods

Iso-C3D-based image guidance was used to place unilateral lag screws and conventional screws in pedicles, isthmi and lateral masses C1–C6. The navigation reference marker array was attached to the Mayfield clamp avoiding any additional skin incisions. Drilling of the screws trajectories was performed using a high speed drill with diamond tip, minimizing the risk of dislocations of cervical vertebrae and/or bone fragments relative to the iso-C3D scan to which the navigation system was registered.

Results

Image-guided percutaneous placement of cervical pedicle, isthmic and lateral mass screws resulted in correct screw placement in all six cases (three hangman fractures, three odontoid fracture Anderson 2 in elderly patients and one C6 posttraumatic pedicular pseudoarthrosis). Average blood loss was 194 ml, total average operating time 106 min and average X-ray time 3.8 min (395 cGy/cm2) including iso-C3D imaging.

Conclusion

The technique presented here was found to be a feasible minimally invasive treatment option for uncomplicated cervical fractures. Besides to our best knowledge, we here present the first percutaneous implantation of lateral mass screws.

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Acknowledgments

CT images were kindly provided by Prof. Müller-Forell, Institute of Neuroradiology, University Medical Center, Johannes Gutenberg-University Mainz, Germany.

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Authors and Affiliations

  1. Department of Neurosurgery, University Medical Centre Mainz, Johannes-Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany

    Sven R. Kantelhardt, Naureen Keric, Jens Conrad, Eleftherios Archavlis & Alf Giese

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  1. Sven R. Kantelhardt
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  2. Naureen Keric
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  3. Jens Conrad
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  4. Eleftherios Archavlis
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Correspondence to Sven R. Kantelhardt.

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Kantelhardt, S.R., Keric, N., Conrad, J. et al. Minimally invasive instrumentation of uncomplicated cervical fractures. Eur Spine J 25, 127–133 (2016). https://doi.org/10.1007/s00586-015-4194-5

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  • DOI: https://doi.org/10.1007/s00586-015-4194-5

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