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ABSTRACT: OBJECTIVE: To evaluate the clinical outcomes and radiographic results of patients who underwent single-level cervical arthroplasty using the Prestige LP. METHOD: Thirty-one patients with single-level cervical disc disease received the Prestige LP disc replacement from June 2008 to December 2009. The neck disability index (NDI), Japanese Orthopedic Association score (JOA) and visual analogue scale (VAS) were used to assessed clinical outcomes pre-operatively and post-operatively at 24 months. The overall cervical alignment (C2-7 Cobb angle), the functional segmental unit (FSU) curvature, the range of motion (ROM) of treated and adjacent levels were measured, and the evidence of heterotopic ossification (HO) was observed from static and dynamic radiographs. RESULTS: There was a statistically significant improvement in the NDI from 20.2 ± 7.5 to 6.4 ± 3.5 (P < 0.000), JOA from 12.8 ± 2.2 to 16.6 ± 0.6 (P < 0.000), the neck VAS score from 4.1 ± 2.5 to 1.4 ± 1.1 (P < 0.000), the arm VAS score from 4.6 ± 2.5 to 0.7 ± 1.1 (P < 0.000). The post-operative overall cervical alignment (9.3° ± 7.2°), ROM of treated level (7.6°) and adjacent level (upper level 9.4° ± 3.1°, lower level 9.1° ± 3.5°) are well maintained. The FSU were 0.2° ± 5.4° and 1.9° ± 5.5° at pre-operation and final follow-up with statistical significance (P = 0.011). Heterotopic ossification was evidenced in five operated segment (16 %). CONCLUSIONS: The Prestige LP disc arthroplasty maintains favorable clinical outcomes, preserves the overall cervical alignment, FSU curvature, ROM of treated level and adjacent levels.
Archives of Orthopaedic and Trauma Surgery 02/2013; · 1.37 Impact Factor
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ABSTRACT: The aim of the present study was to determine the significance of diabetes on degradation of intervertebral disc (IVD) extracellular matrix. Diabetic rats showed a significant increase in glucose and sorbitol contents in the IVD. The levels of aldose reductase (AR), p38 and metalloproteinases, and degradation of metalloproteinase-derived aggrecan and type II collagen were increased, while tissue inhibitors of metalloproteinases levels were decreased in the IVD of diabetic rats. These changes were markedly affected by inhibition of AR or p38. Diabetes might contribute to enhanced matrix degradation in the IVD and the polyol pathway might mediate this process via p38 activation.
Connective tissue research 12/2012; · 1.55 Impact Factor
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ABSTRACT: PURPOSE: To verify the relationship between neurologic deficit after spinal cord injury without radiologic evidence of trauma (SCIWORET) and coexisting cervical disc herniation (CDH). METHODS: A retrospective review was made to compare the neurologic and radiological outcomes in SCIWORET patients with and without CDH. The neurologic deficit was evaluated by the American Spinal Injury Association (ASIA) scale at admission and last follow-up. The radiological evaluation was performed with magnetic resonance imaging to determine the maximum canal compromise (MCC) and maximum spinal cord compression (MSCC). RESULTS: Prevalence of CDH was 37.1 % among all 70 SCIWORET cases. There was no significant difference between the CDH and non-CDH group in the ASIA grade at admission and last follow-up and the improvement. Patients with CDH had more substantial MSCC (P < 0.05) but not MCC than those without CDH. No significant correlation was noted between the extent of MSCC or MCC and the initial and final neurologic functions. 12 of 26 patients with CDH underwent anterior cervical discectomy fusion, while the remaining 14 received anterior cervical corpectomy fusion. No significant difference was noted in the neurologic outcomes between the two techniques. CONCLUSIONS: CDH in most patients with SCIWORET likely occurred before rather than after trauma. CDH caused more severe cord compression but did not aggravate the neurologic injury. The extent of MSCC had no association with the initial neurologic deficit or final recovery.
Archives of Orthopaedic and Trauma Surgery 11/2012; · 1.37 Impact Factor
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ABSTRACT: PURPOSE: To retrospectively evaluate the outcome of C1-2 transarticular screws combined with C1 laminar hooks fixation. METHODS: All patients underwent atlantoaxial fixation during a 5-year period. The surgical technique and treatment procedures were intensively reviewed and clinical symptoms, neurological function and imaging appearance were retrospectively evaluated. RESULTS: The clinical and radiology follow-up indicated a stable arthrodesis and clinical relief from symptoms for all patients. All patients with neurological defects improved an average of 1.33 grade at their most recent clinical assessment, P < 0.05; their average admission ASIA motor score, pin prick score and light touch score improved to an average follow-up ASIA score of 99.80 (99.83 ± 0.38), 111.83 (111.83 ± 0.45), and 111.89 (111.89 ± 0.32), respectively. No neurovascular impairment and case of implant failure were observed. CONCLUSIONS: The C1-2 transarticular screws combined with C1 laminar hooks fixation is a reliable technique for atlantoaxial instability.
European Spine Journal 08/2012; · 1.97 Impact Factor
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ABSTRACT: PURPOSE: The goal of this study was to determine which paraspinal approach provided a better transverse screw angle (TSA) for each vertebral level in lower lumbar surgery. METHODS: Axial computed tomography (CT) images of 100 patients, from L3 to S1, were used to measure the angulation parameters, including transverse pedicle angle (TPA) and transverse cleavage plane angle (TCPA) of entry from the two approaches. The difference value between TCPA and TPA, defined as difference angle (DA), was calculated. Statistical differences of DA obtained by the two approaches and the angulation parameters between sexes, and the correlation between each angulation parameter and age or body mass index (BMI) were analyzed. RESULTS: TPA ranged from about 16° at L3 to 30° at S1. TCPA through the Wiltse's and Weaver's approach ranged from about -10° and 25° at L3 to 12° and 32° at S1, respectively. The absolute values of DA through the Weaver's approach were significantly lower than those through the Wiltse's approach at each level. The angulation parameters showed no significant difference with sex and no significant correlation with age or BMI. CONCLUSIONS: In the lower lumbar vertebrae (L3-L5) and S1, pedicle screw placement through the Weaver's approach may more easily yield the preferred TSA consistent with TPA than that through the Wiltse's approach. The reference values obtained in this paper may be applied regardless of sex, age or BMI and the descriptive statistical results may be used as references for applying the two paraspinal approaches.
European Spine Journal 08/2012; · 1.97 Impact Factor
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ABSTRACT: INTRODUCTION: We report a case of isolated intra-spinal tuberculosis in a 45 year-old woman. The uncommon findings in MRI were more suggestive of tumor lesion. MATERIALS AND METHODS: After 3 month history of low back pain and 2 weeks radiated pain of right lower extremity, an operation was performed and the total intra-spinal mass was resected. Histological examination revealed a granulomatous necrosis with caseum. Symptoms were greatly improved postoperatively and then the patient was treated with four anti-tuberculosis drugs. CONCLUSION: This case indicated the complexity of differentiating atypical spinal tuberculosis from disease which could cause spinal cord and cauda equina compression.
European Spine Journal 04/2012; · 1.97 Impact Factor
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ABSTRACT: OBJECTIVE: To design and attest the role of hydroxycamptothecin liposomes (L-HCPT) as a new delivery system to prevent epidural scar adhesions after laminectomy in a rabbit model. METHODS: Lumbar laminectomies at L6 were performed on 18 mature male New Zealand rabbits. The rabbits were randomly divided into three groups: (I) a cotton pad soaked with 0.05 % hydroxycamptothecin (HCPT) solution was kept on the laminectomy area for 5 min before the layers were sutured (HCPT group); (II) 25 mg of liposomes containing 0.01 % HCPT was implanted on the laminectomy area (L-HCPT group); and (III) the laminectomy area was flushed with saline (control group). The rabbits were killed 4 weeks after the operation. Macroscopic evaluation and histological analysis of epidural scar adhesion were employed with hematoxylin-eosin and Masson staining, followed by hydroxyproline (Hyp) quantification and magnetic resonance imaging (MRI) of postoperative rabbit scar tissues. The epidural scar area and number of fibroblasts in the scar tissue were also evaluated. RESULTS: In the laminectomy sites of rabbits treated with HCPT or L-HCPT, the dura mater and nerve root were clean without evident scar adhesion. Hyp concentration was significantly lower in these two groups compared with the saline-control group. On the other hand, the MRI of postoperative rabbits showed apparent decreased fibrosis around the dura mater in these two groups compared with the control group. In addition, the epidural scar area and the number of fibroblasts were significantly lower in the two groups compared with the control group. CONCLUSION: These results demonstrate that the treatment of postlaminectomy wounds with L-HCPT may reduce and prevent the severity of adhesion.
European Journal of Orthopaedic Surgery & Traumatology 03/2012; · 0.10 Impact Factor
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ABSTRACT: Spontaneous infectious spondylodiscitis (SIS) is an uncommon condition. The purpose of this retrospective study of 10 adult patients (6 males and 4 females, average age 52 years), all with lumbar SIS and epidural abscess, was to analyze the efficacy of single-stage posterior debridement plus single-level interbody grafting with autologous bone, and transpedicular screw-rod instrumentation. The mean follow-up period was 43 months, with a minimum of 30 months. The back pain was relieved within 3 to 8 days after surgery. Neurologic deficits, present in 5 cases, all improved. Solid fusion was achieved at 6 months in all 10 cases. The mean VAS for pain improved from 7.5 to 1.6, the mean Oswestry Disability Index from 57.8% to 8.1%. The mean physical component of SF-36 (PCS) improved from 32.4% to 54.7%, the mean mental component of SF-36 (MCS) improved from 33.8% to 57.2%. All these changes were significant (p < 0.001). No recurrence of infection was noted. The outcome was quite satisfactory in terms of fusion rate and quality of life.
Acta orthopaedica Belgica 12/2011; 77(6):816-22. · 0.40 Impact Factor
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ABSTRACT: Transarticular screw fixation is used in the upper cervical and lumbar spine to achieve posterior spinal stability, and its biomechanical performance has been proven to be similar to that of pedicle screw fixation. However, few studies have reported the use of transarticular screw fixation in the upper thoracic spine.
To biomechanically compare transarticular screws with pedicle screws in short-term cyclic loading in the upper thoracic spine.
Eight fresh human cadaveric spine specimens (T1-T3) were harvested and tested for 6 cycles in flexion, extension, lateral bending, and torsion in their intact condition. Each specimen was then destabilized and restabilized with 3 fixation methods: the pedicle screw/rod construct, the transarticular screw/rod construct, and transarticular screws alone. The instrumented specimens were reteted with the same protocol.
All fixation systems reduced the range of motion significantly with respect to flexion, extension, lateral bending, and axial rotation (P < .01). However, no significant difference was observed between the 3 instrumented groups.
This biomechanical study demonstrates in vitro that transarticular screws and pedicle screws have statistically similar biomechanical stability in a noncorpectomy model. Posterior transarticular screws may be an alternative for internal fixation in the upper thoracic spine.
Neurosurgery 12/2011; 69(2 Suppl Operative):ons141-5; discussion ons146. · 2.79 Impact Factor
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ABSTRACT: Although pedicle screw fixation has been increasingly used in the upper thoracic spine in recent years, controversies exist about the safety and complications such as nerve or vascular intrusion associated with the technique. In this study, an alternative method of transarticular screw fixation was validated.
Morphometric analysis was performed on computed tomography (CT) scans of the upper thoracic zygapophysial joints of C7, T1, T2 and T3 in 20 male and 20 female patients in the axial and sagittal planes. The degree of screw angulation was recorded in the sagittal and axial planes and the screw length was measured at the spinal level from C7 to T3.
The smallest medial-lateral diameter and anterior-posterior diameter of IAP was found at T3 in the female patients and C7 in the male patients. The screw trajectory length ranged from 14.9 to 20.5 mm in all patients. All the above measurements were significantly different between male and female patients at all levels (P < 0.05). The mean value of screw trajectory angle was 19.3°-20.1° in the axial plane and 44.3°-45.7° in the sagittal plane. There was no statistically significant difference (P > 0.05) between male and female patients in the axial and sagittal angles.
The morphometric data of C7-T3 zygapophysial joints indicate the suitable screw diameter and screw length for this technique. Transarticular screw fixation proved to be a potentially safe alternative to pedicle screw fixation in this region.
European Spine Journal 11/2011; 21(6):1186-91. · 1.97 Impact Factor
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ABSTRACT: This letter is to report and discuss two cases of psychogenic paralysis after spinal surgery in order to increase the vigilance and assist in the diagnosis and treatment of this uncommon disorder. The medical records for two middle-aged men who presented complete loss of extremities function after spinal surgery were reviewed retrospectively. None had a history of a previous hysterical seizure. Both of the patients' symptoms and signs differ from the correct anatomic pattern of a neurological deficit. Both of them spontaneously recovered and discharged from the hospital uneventful eventually. The orthopedic surgeons must recognize hysterical paralysis to avoid unnecessary surgery. A heightened awareness of a nonanatomic functional deficit on physical examination could help to reduce frustration and delay in diagnosis associated with this disorder. Rapid recovery should be expected, but the surgeon should administrate proper treatment.
Rheumatology International 11/2011; · 1.88 Impact Factor
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ABSTRACT: To study the diagnosis and treatment strategy of esophagus perforation complicating anterior cervical spine surgery.
From 2000 to 2010, we performed 1,045 cases of anterior cervical surgeries. One developed esophagus perforation. The diagnosis and treatment strategy of this case and the other five patients with esophagus perforation from other hospitals were retrospectively reviewed. For an intraoperative perforation, primary double layer suture was performed. Postoperatively, the patient took nutrition by a nasogastric tube instead of oral intake for one week. For three cases of perforations early in the post-operative period, oral intake was forbidden and nasogastric tube was conducted for nutrition support. The wound was debrided and open drainage was conducted postoperatively. Intravenous broad-spectrum antibiotic therapy was utilized. For perforations at postoperative year 3 and 7, prohibition of oral intake, intravenous broad-spectrum antibiotics therapy, and nasogastric tube nutrition support were all conducted and surgical debridement was performed. In operation, fixation plates and screws were removed, and the edges of the perforation were loosely approximated by synthetic absorbable sutures. Postoperatively, skin wound was kept open for drainage.
All the perforations healed evenly without secondary complications.
When a perforation is suspected, imaging techniques should be employed. Surgical treatment facilitates the healing of esophagus perforation. Supportive treatments including prohibition of oral intake, intravenous broad-spectrum antibiotic therapy, feeding with a nasogastric tube were mandatory parts of treatments.
European Spine Journal 08/2011; 21(1):172-7. · 1.97 Impact Factor
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ABSTRACT: Various techniques have been described for posterior atlantoaxial fusion. Sublaminar passage of the wire/cable is cumbersome with a risk of spinal cord injury. Packing morselized bone grafts into the C1-2 facet joints may be difficult and it may cause massive bleeding and neuropathic pain or posterior scalp numbness postoperatively. We introduce a modified method by using C1-2 screw-rod fixation (SRF) to compress a structural iliac bone graft between the posterior elements of C1 and C2 without supplemental wiring construct.
From December 2006 to May 2009, 35 consecutive patients with atlantoaxial instability treated by this method were reviewed retrospectively. Clinical and radiographic history was recorded. Patients with neck pain had relieved significantly after surgery and the neurologic status was also improved greatly. Thirty-three (94.3%) patients gained bony fusion at 3 months postoperatively. No vertebral artery and spinal cord injuries were noted. There was no instrumentation failure during the observation period.
We conclude that the C1-2 SRF with construct-compression structural bone grafting can be used for C1-2 fusion with relatively simple performance and less time-consuming in selected cases.
European Spine Journal 08/2011; 21(1):156-64. · 1.97 Impact Factor
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ABSTRACT: Spontaneous discitis is unusual and typically affects children. Hematogenous delivery of an infectious organism is the likely main cause. Common treatment method including conservative and surgical treatments, which also needs prolonged antimicrobial therapy based on an effective inhibitory concentration, can be achieved on the local disc space. Intradiscal antibiotic concentration was measured after the disc was harvested after preventive administration of antibiotics in previous studies. On the one hand the disc cannot simulate the infection situation when the inflammation leads to end plate destruction, vascular invasion and increase of permeability. On the other hand antibiotic concentrations were measured in vitro which cannot tell the actual situation in vivo. It is necessary to find a reliable evaluation method to decide whether the antibiotic can penetrate and make an effective inhibitory concentration in the local disc at the beginning of the treatment in vivo. Systemic antibiotics like nutrients enter and leave the disc by the only way of passive diffusion. The postcontrast MRI has been widely used as a noninvasive method of studying transport into the disc. The enhancement following contrast administration can be measured in T1 sagittal MR images by placing suitable cursors and evaluating the signal intensity (SI) of the region. Therefore we hypothesise that serial postcontrast MRI can be used to measure antibiotic concentration in the infected intervertebral disc in vivo. If the hypothesis is verified, we can better determine the choice of antibiotics and antibiotic treatment regime at the beginning of the treatment to improve the treatment success rate.
Medical Hypotheses 07/2011; 77(4):624-5. · 1.39 Impact Factor
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ABSTRACT: A rare case of a 44-year-old Chinese male with diffuse idiopathic skeletal hyperostosis (DISH) and simultaneous ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF) at T1-2 causing thoracic myelopathy is reported herein. Posterior decompression without extirpating the OPLL was performed at T1-2. Postoperatively, symptoms were greatly improved, with remaining hyperreflexia and Grade 4/5 muscle strength in the lower extremities. The Japanese Orthopedic Association score improved from 5 preoperatively to 9 at final follow-up. The presence of a cyst due to leakage of cerebrospinal fluid was confirmed by MRI at day 27, but it resolved after conservative management. The clinical manifestation of DISH, the relationship among DISH, OPLL, and OLF, and management of thoracic myelopathy due to OPLL and OLF were reviewed.
European Spine Journal 07/2011; 20 Suppl 2:S195-201. · 1.97 Impact Factor
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ABSTRACT: To evaluate the outcomes of anterior hybrid decompression and segmental fixation for adjacent three-level cervical spondylosis.
53 patients with adjacent three-level cervical spondylosis underwent anterior hybrid decompression and segmental fixation. Titanium mesh and PEEK cage were used to span the defects due to decompression and anterior locking plate was placed over the entire construct. Japanese Orthopedic Association (JOA) scores, segmental and C2-C7 angles before and after operation were analyzed.
The average follow up was 37.3 ± 7.0 months. Bone fusions were observed in all patients at follow-up intervals. JOA scores improved from preoperative 8.1 ± 2.2 (range 4-13) to 13.1 ± 2.3 (range 7-16) at final follow-up (P = 0.000). Meanwhile, surgical segmental angle was significantly improved from preoperative 6.9 ± 8.3° (range -10.4° to 27.6°) to postoperative 16.3 ± 7.2° (range -2.0° to 37.6°)(P = 0.000), and C2-C7 angle from 9.7 ± 8.6° (range -9.9° to 27.4°) to 17.8 ± 7.7° (range -1.2° to 34.3°) (P = 0.000). Postoperative complications included C5 palsy, cerebrospinal fluid leakage, hematoma, and titanium mesh subsidence.
Anterior hybrid decompression and segmental fixation is a safe and effective procedure for adjacent three-level cervical spondylosis.
Archives of Orthopaedic and Trauma Surgery 05/2011; 131(5):631-6. · 1.37 Impact Factor
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ABSTRACT: Epidural adhesion and fibrosis attribute to the prevalence of pain in normal wound healing after laminectomy surgery. Hydroxycamptothecin (HCPT), an antitumor drug, has proved to be effective in preventing fibroblast proliferation and reducing epidural adhesion after laminectomy in vivo animal study. However, HCPT's disadvantages, such as poor solubility and short half-life, limit its application clinically. Compared with HCPT, the liposome-encapsulated HCPT (L-HCPT) could reduce epidural fibrosis by preventing the proliferation of fibroblast in the scar tissues with longer half-life and increased solubility.
To evaluate the suitability of L-HCPT in the laminectomy models on rabbits and to explore the mechanisms in the prevention of epidural scar formation.
An original investigation that characterizes the novel delivery system in the combinational application of HCPT and liposome (L-HCPT).
The sample comprises 24 mature New Zealand white adult rabbits.
Lumbar laminectomies at L4 and L6 with an L5 disc injury were performed on 24 mature New Zealand white adult rabbits. The rabbits were then randomized into three groups. In Group I, the laminectomy site was treated with a cotton pad soaked with HCPT solution (1 mg/mL) for 5 minutes (HCPT group) and was flushed with saline completely. In Group II, 1 mL of L-HCPT was seeded on the laminectomy area (L-HCPT group). In Group III, the laminectomy area was flushed with saline before wound closure (control group). After 28 days, the animals underwent magnetic resonance imaging. The animals were euthanized; the spinal section was removed for macroscopic evaluation, and hydroxyproline in the scar tissue was quantified.
Operation in all the animals yielded a reproducible laminectomy, without complication or mortality. In the laminectomy sites treated with L-HCPT, the dura mater was clean without any evident adhesion. Magnetic resonance imaging analysis implied that L-HCPT treatment could reduce the epidural scar significantly compared with saline control group, which was further proved by the decreased concentration of hydroxyproline in the scar tissues.
These results demonstrate that the treatment of postlaminectomy wounds in rabbits with L-HCPT reduces the severity of adhesion.
The spine journal: official journal of the North American Spine Society 03/2011; 11(3):218-23. · 2.90 Impact Factor
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ABSTRACT: BACKGROUND:: Transarticular screw fixation is used in the upper cervical and lumbar spine to achieve posterior spinal stability, and its biomechanical performance is proven to be similar to that of pedicle screw fixation. However, few studies have reported the use of transarticular screw fixation in the upper thoracic spine. OBJECTIVE:: To biomechanically compare transarticular screws with pedicle screws in short-term cyclic loading in the upper thoracic spine. METHODS:: Eight fresh human cadaveric spine specimens (T1-T3) were harvested and tested for six cycles in flexion, extension, lateral bending and torsion in their intact condition. Each specimen was then destabilized and restabilized with three fixation methods: the pedicle screw/rod construct, the transarticular screw/rod construct, and transarticular screws alone. The instrumented specimens were retested using the same protocol. RESULTS:: All fixation systems reduced the range of motion significantly with respect to flexion, extension, lateral bending and axial rotation (P<0.01). However, no significant difference was observed between the three instrumented groups. CONCLUSION:: This biomechanical study demonstrates in vitro that transarticular screws and pedicle screws have statistically similar biomechanical stability in a non-corpectomy model. Posterior transarticular screws may afford an alternative for internal fixation in the upper thoracic spine.
Neurosurgery 03/2011; · 2.79 Impact Factor
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ABSTRACT: The purpose of this article is to compare the outcomes of three different anterior approaches for three-level cervical spondylosis. The records of 120 patients who underwent anterior approaches because of three-level cervical spondylosis between 2006 and 2008 were reviewed. Based on the type of surgery, the patients were divided into three groups: Group 1 was three-level anterior cervical discectomy and fusion (ACDF); Group 2 anterior cervical hybrid decompression and fusion (ACHDF, combination of ACDF and ACCF); and Group 3 two-level anterior cervical corpectomy and fusion (ACCF). The clinical outcomes including blood loss, operation time, complications, Japanese Orthopedic Association (JOA) scores, C2-C7 angle, segmental angle, and fusion rate were compared. There were no significant differences in JOA improvement and fusion rate among three groups. However, in terms of segmental angle and C2-C7 angle improvement, Group 2 was superior to Group 3 and inferior to Group 1 (all P < 0.01). Group 2 was less in operation time than Group 3 (P < 0.01) and more than Group 1 (P < 0.01). Group 3 had more blood loss than Group 1 and Group 2 (all P < 0.01) and had higher complication rate than Group 1 (P < 0.05). No significant differences in blood loss and complication rate were observed between Group 1 and Group 2 (P > 0.05). ACDF was superior in most outcomes to ACCF and ACHDF. If the compressive pathology could be resolved by discectomy, ACDF should be the treatment of choice. ACHDF was an ideal alternative procedure to ACDF if retro-vertebral pathology existed. ACCF was the last choice considered.
European Spine Journal 03/2011; 20(9):1539-44. · 1.97 Impact Factor
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ABSTRACT: Transarticular screw fixation (TASF) is technically demanding, with high risk of vertebral artery (VA) injury. How to manage intraoperative VA injury and choose optimal alternative fixation becomes a concern of spinal surgeons. In this study, the management strategy for a patient with suspected intraoperative VA injury was analyzed. A 53-year-old woman developed type II odontoid fracture and brain stem injury due to a motor vehicle accident 3 months earlier. After conservative treatments, the brain stem injury improved, but with residual ocular motility defect in the right eye. The odontoid fracture did not achieve fusion with displacement and absorption of fracture fragments. After admission, atlantoaxial fixation using bilateral C1-2 transarticular screws (TASs) combined with C1 laminar hooks was planed. The first TAS was inserted successfully. Unfortunately, suspected VA injury developed during tapping the tract for the second TAS. Considering the previous brain stem injury and that directly inserting the screw to tamponade the hemorrhage might cause VA stenosis or occlusion, we blocked the screw trajectory with bone wax. C2 laminar screw was implanted instead of intended TAS on the injured side. The management strategy for suspected VA injury should depend on intraoperative circumstances and be tailored to patients. Blocking screw trajectory with bone wax is a useful method to stop bleeding. Atlantoaxial fixation using C2 laminar screw and C1-2 TAS combined with C1 laminar hooks is an ideal alternative procedure.
Archives of Orthopaedic and Trauma Surgery 02/2011; 131(9):1207-10. · 1.37 Impact Factor
