Minimally Invasive Atlantoaxial Fusion

Department of Neurosurgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90095, USA.
Neurosurgery (Impact Factor: 3.62). 03/2010; 66(3 Suppl):193-7. DOI: 10.1227/01.NEU.0000366107.69895.74
Source: PubMed


C1-C2 fusion has significantly advanced from predominantly wiring/cable modalities to more biomechanically stable screw-rod techniques. Minimally invasive surgical techniques represents the most recent modification of atlantoaxial fixation. The indications, rationale, and surgical technique of this novel procedure are described.
Six patients requiring C1-C2 fusion (5 type II odontoid fractures and 1 os odontoideum) underwent minimally invasive C1-C2 fusion over a 2-year period. The cohort consisted of 5 men and 1 woman with a mean age of 51 years (age range, 39-64 y). All 6 patients underwent bilateral segmental atlantoaxial fixation using an expandable tubular retractor.
The mean follow-up time was 32 months (age range, 24-46 mo) There were no intraoperative complications, and the mean estimated blood loss was 100 mL. Solid fusion was achieved in all 6 patients, without pathological motion on dynamic studies. Postoperative computed tomographic images showed no hardware malposition in the scanned patients (4 of the 6 patients).
Placement of C1 and C2 instrumentation using minimally invasive techniques is technically feasible. Because the instrumentation and the means of obtaining arthrodesis do not differ substantively from the standard approach, we would not anticipate long-term results to be different from those of an open procedure, apart from the approach-related morbidity.

3 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: The plasma-generating parts of ion sources including their power supplies are usually floated to high potential (ion extraction voltage), thus requiring great insulation efforts and causing high costs for high-energy ion beams. A new concept for pulsed ion sources is presented in which a single power supply is used to simultaneously produce the plasma and high extractor voltage via a modified Marx generator. Proof-of-principle experiments have been performed with high-current spark discharges in vacuum where multiply charged ions are produced with this Marx-generator-based ion source (“Magis”). Using “Magis”, it has been demonstrated that pulsed ion beams of very high energies can be obtained with relatively low voltage. For copper, ions of charge states up to 7+ have been found whose energy was 112 keV for a charging voltage of only 10 kV
    IEEE Transactions on Plasma Science 09/1997; 25(4-25):718 - 721. DOI:10.1109/27.640693 · 1.10 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: In this paper we create "three-point service-oriented conceptual design and modeling methodology" for Web services composition based on the object-oriented research results in MERODE, thus on the concept level we firstly clarify the research issue on the semantic consistency of Web services composition. Afterwards, on the logic level we precisely define and demonstrate the semantic consistency of Web services composition through using some standard schemes of an order system. These aspects of research results can effectively and significantly tackle one big inhibitors of Web services adoption: a lack of semantic consistency in business processes within Web services interactions and composition.
    Multimedia Software Engineering, 2004. Proceedings. IEEE Sixth International Symposium on; 01/2005
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: To review published series describing C1-2 posterolateral instrumentation, comparing outcomes in patients who had and did not have C2 nerve sacrifice. METHODS: Online databases were searched for English-language articles between 1994 and April 2011 pertaining to posterior atlantoaxial instrumentation with C1 lateral mass and C2 screws. Twenty studies describing 732 patients with C2 nerve preservation and 6 studies describing 361 patients with C2 sacrifice met inclusion criteria. RESULTS: All but one small study without a control group were retrospective case series, making all evidence class III. Excluding C2 nerve dysfunction, no neurological deterioration was observed. Three instances of vertebral artery injury were secondary to soft tissue dissection and one was secondary to C1 screw insertion. There were seven instances of C1 screw malposition in the preservation group and none in the section group. Reported in roughly 20% of patients, mean estimated blood loss tended to be lower with C2 nerve sectioning (213 vs. 471 mL) and operative times were somewhat shorter (118 vs. 132 minutes). C2 nerve section resulted in greater symptomatic numbness (11.6% vs. 1.3%; P < 0.0001) but less neuropathic pain (0.3% vs. 4.7%; P = 0.0002) compared with C2 preservation. CONCLUSIONS: Sacrifice of the C2 nerve root to aid in the insertion of C1 lateral mass screws when performing posterior atlantoaxial instrumented fusions is a treatment option (class III). It may decrease blood loss and operative duration, potentially advantageous in elderly or frail patients. Numbness occurred in roughly 12% of patients, an outcome that may be unacceptable to certain patient populations, but neuropathic pain was nearly absent in reported studies with nerve section. C2 nerve preservation and retraction for C1 screw placement may have higher incidence of neuropathic pain (∼5%). Rates of fusion are universally high independent of C2 nerve technique.
    World Neurosurgery 11/2011; 78(6). DOI:10.1016/j.wneu.2011.10.035 · 2.88 Impact Factor
Show more