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首页> 外文期刊>Neurosurgical focus >Neuronavigation and 3D fluoroscopy–guided lag screw reduction and osteosynthesis for traumatic spondylolistheses of the axis: a path worth exploring?
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Neuronavigation and 3D fluoroscopy–guided lag screw reduction and osteosynthesis for traumatic spondylolistheses of the axis: a path worth exploring?

机译：神经导航和3D透视引导下的拉力螺钉复位和骨合成治疗轴外伤性腰椎滑脱：值得探索的路径吗？

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OBJECTIVE In traumatic spondylolistheses of the axis, there is a marked heterogeneity of the observed injury patterns, with a wide range of the severity—from stable fractures, which can be treated conservatively with very good success, to highly unstable fractures, which should be treated surgically. A number of classification systems have been devised to assess the instability of the injuries and to derive a corresponding therapy recommendation. In particular, the results and recommendations regarding medium-severity cases are still inconclusive. Minimally invasive percutaneous procedures performed using modern techniques such as 3D fluoroscopy and neuronavigation have the potential for improvements in the therapeutic outcome and procedural morbidity against open surgical procedures and conservative therapy. METHODS A minimally invasive method using 3D fluoroscopy and neuronavigation for percutaneous lag screw osteosynthesis of the pars interarticularis was performed in 12 patients with a Levine-Edwards Type II fracture. Ten patients had an isolated hangman’s fracture and 2 patients had an additional odontoid fracture of the axis (Type II according to the Anderson and D’Alonzo classification system). Complications, operating parameters, screw positions, and bony fusion were evaluated for the description and evaluation of the technique. RESULTS In 6 men and 6 women, percutaneous lag screw osteosynthesis was performed successfully. Correct placement could be verified postoperatively for all inserted screws. In the case series, nonunion was not observed. In all patients with a complete follow-up, a bony fusion, an intact vertebral alignment, and no deformity could be detected on CT scans obtained after 3 months. CONCLUSIONS The percutaneous pars interarticularis lag screw osteosynthesis is a minimally invasive and mobility-preserving surgical technique. Its advantages over alternative methods are its minimal invasiveness, a shortened treatment time, and high fusion rates. The benefits are offset by the risk of injury to the vertebral arteries. The lag screw osteosynthesis is only possible with Levine-Edwards Type II fractures, because the intervertebral joints to C-3 are functionally preserved. A further development and evaluation of the operative technique as well as comparison with conservative and alternative surgical treatment options are deemed necessary.
机译：目的在外伤性椎体峡部裂伤中，观察到的损伤类型存在明显的异质性，严重程度从稳定的骨折（可以通过保守治疗取得很好的成功）到高度不稳定的骨折（应治疗）手术。已经设计出许多分类系统来评估损伤的不稳定性并得出相应的治疗建议。特别是，关于中等严重度病例的结果和建议仍然没有定论。使用现代技术（例如3D透视和神经导航）进行的微创经皮手术可能会改善治疗效果和针对开放式手术和保守疗法的手术发病率。方法对12例Levine-Edwards II型骨折患者，采用3D透视和神经导航技术进行微创方法，以经皮穿刺螺钉固定关节间隙。十名患者发生了孤立的绞刑骨折，另外2例患者发生了另外的轴齿状骨折（根据Anderson和D'Alonzo分类系统分类为II型）。对并发症，操作参数，螺钉位置和骨融合进行了评估，以描述和评估该技术。结果6例男性和6例女性成功进行了经皮滞后螺钉接骨术。可以在术后检查所有插入的螺钉的正确放置。在案例系列中，未观察到骨不连。在所有接受了完整随访的患者中，三个月后进行的CT扫描均未发现骨融合，完整的椎体排列并且未发现畸形。结论经皮穿刺关节间隙滞后螺钉植骨是一种微创且可保持活动性的外科手术技术。与替代方法相比，它的优势在于其侵入性最小，治疗时间缩短和融合率高。这些好处被椎动脉受伤的风险所抵消。仅在Levine-Edwards II型骨折中才可以进行拉力螺钉的骨合成，因为C-3的椎间关节在功能上得以保留。手术技术的进一步发展和评估以及与保守和替代性手术治疗方案的比较被认为是必要的。

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