Objective To compare the clinical outcomes of transoral anterior Jefferson-fracture reduction plate (JeRP) and posterior screw rod (PSR) surgery for unstable atlas fractures via C1-ring osteosynthesis.
Methods From June 2009 to June 2022, 49 consecutive patients with unstable atlas fractures were treated by transoral anterior JeRP fixation (JeRP group) or PSR fixation (PSR group) and followed up at General Hospital of Southern Theatre Command of PLA; 30 males and 19 females were included. The visual analogue scale (VAS) score, Neck Disability Index (NDI), distance to anterior arch fracture (DAAF), distance to posterior arch fracture (DPAF), lateral mass displacement (LMD), Redlund-Johnell value, postoperative complications, and fracture healing rate were retrospectively collected and statistically analyzed.
Results Compared with that in the PSR group, the bleeding volume in the JeRP group was lower, and the length of hospital stay was longer. The VAS scores and NDIs of both groups were significantly improved after surgery. The postoperative DAAF and DPAF were significantly smaller after surgery in both groups. Compared with the significantly shorter DPAF in the PSR group, the JeRP group had a smaller DAAF, shorter LMDs and larger Redlund-Johnell value postoperatively and at the final follow-up. The fracture healing rate at 3 months after surgery was significantly greater in the JeRP group (p < 0.05).
Conclusion Both C1-ring osteosynthesis procedures for treating unstable atlas fractures yield satisfactory clinical outcomes. Transoral anterior JeRP fixation is more effective than PSR fixation for holistic fracture reduction and short-term fracture healing, but the hospital stay is longer.
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Motion preserving C1 ring lateral mass screw fixation with transverse rod for isolated unstable Jefferson fracture of atlas vertebra: a multicentric study Nathan Beucler, Anis Choucha, Kaissar Farah, Mikael Meyer, Arnaud Dagain, Stéphane Fuentes European Spine Journal.2026; 35(2): 936. CrossRef
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Objective The surgical management of basilar invagination without atlantoaxial dislocation (type B basilar invagination) remains controversial. Hence, we have reported the use of posterior intra-articular C1–2 facet distraction, fixation, and cantilever technique versus foramen magnum decompression in treating type B basilar invagination as well as the results and surgical indications for this procedure.
Methods This was a single-center retrospective cohort study. Fifty-four patients who underwent intra-articular distraction, fixation, and cantilever reduction (experimental group) and foramen magnum decompression (control group) were enrolled in this study. Distance from odontoid tip to Chamberlain’s line, clivus-canal angle, cervicomedullary angle, craniovertebral junction (CVJ) triangle area, width of subarachnoid space and syrinx were used for radiographic assessment. Japanese Orthopedic Association (JOA) scores and 12-item Short Form health survey (SF-12) scores were used for clinical assessment.
Results All patients in the experimental group had a better reduction of basilar invagination and better relief of pressure on nerves. JOA scores and SF-12 scores also had better improvements in the experimental group postoperation. SF-12 score improvement was associated with preoperative CVJ triangle area (Pearson index, 0.515; p = 0.004), cutoff value of 2.00 cm2 indicating the surgical indication of our technique. No severe complications or infections occurred.
Conclusion Posterior intra-articular C1–2 facet distraction, fixation, and cantilever reduction technique is an effective treatment for type B basilar invagination. As various factors involved, other treatment strategies should also be investigated.
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Objective Although a retro-odontoid pseudotumor associated with rheumatoid arthritis is a well-known clinical entity, little is known about retro-odontoid pseudotumors not associated with rheumatoid arthritis due to their rarity.
Methods Between 2006 and 2019, consecutive patients with nonrheumatoid pseudotumors were included and retrospectively compared with patients with rheumatoid pseudotumors.
Results Nineteen patients had nonrheumatoid pseudotumors (mean age, 73 ± 6 years; male, 53%). All had cervical lesions including ossified anterior and posterior longitudinal ligaments with a history of cervical surgery in 5. The mean thickness of the pseudotumors at diagnosis was 8.1 mm (range, 4.2–17.2 mm). Pseudotumor thickness had a significant negative correlation with the atlantodental interval (p = 0.008) and the subaxial range of motion (p = 0.049). In comparison with 7 rheumatoid pseudotumor patients, nonrheumatoid pseudotumor patients were older (p = 0.042), had a higher proportion of males (p = 0.023), had a smaller atlantodental interval (p = 0.007), and had larger pseudotumors at diagnosis (p = 0.030). Of the 19 patients, 18 received posterior fixation with or without C1 laminectomy, while the other received C1 laminectomy alone. The percent pseudotumor thickness at follow-up to those at diagnosis was 91%, 77%, 68%, 46%, 58%, and 49% at 1, 3, 6, 12, 24, and 36 months after surgery, respectively.
Conclusion This study revealed markedly clinical and radiological differences between nonrheumatoid and rheumatoid pseudotumors. The main etiology for nonrheumatoid pseudotumors was subaxial cervical degeneration and ossified lesions. There were good outcomes following posterior fixation and time-dependent pseudotumor regression within 12 months.
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C1 laminoplasty and posterior atlantoaxial fusion for large retro-odontoid pseudotumor with Instability: A technical note Masato Tanaka, Selim Ayhan, Taro Yamauchi, Shinya Arataki, Yoshihiro Fujiwara, Akihiro Kanemaru, Shin Masuda, Kenta Torigoe, Yasuyuki Shiozaki Interdisciplinary Neurosurgery.2022; 28: 101478. CrossRef
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Luca Papavero, Gregor Schmeiser, Ralph Kothe, Bronek Boszczyk, Oliver Heese, Yoshiharu Kawaguchi, Anna MacDowall, Claes Olerud, Nikolaos Paidakakos, Anastasios Panagiotou, Tobias Pitzen, Marcus Richter, K. Daniel Riew, Aaron Stevenson, Lee Tan, Ryo Ueshima, YH Yau, Michael Mayer
Neurospine 2020;17(1):164-171. Published online July 9, 2019
Objective To validate with a prospective study a decision-supporting coding system for the surgical approach for multilevel degenerative cervical myelopathy.
Methods Ten cases were presented on an internet platform, including clinical and imaging data. A single-approach (G1), a choice between 2 (G2), or 3 approaches (G3) were options. Senior and junior spine surgeons analyzed 7 parameters: location and extension of the compression of the spinal cord, C-spine alignment and instability, general morbidity and bone diseases, and K-line and multilevel corpectomy. For each parameter, an anterior, posterior, or combined approach was suggested. The most frequent letter or the last letter (if C) of the resulting 7-letter code (7LC) suggested the surgical approach. Each surgeon performed 2 reads per case within 8 weeks.
Results G1: Interrater reliability between junior surgeons improved from the first read (κ = 0.40) to the second (κ = 0.76, p < 0.001) but did not change between senior surgeons (κ = 0.85). The intrarater reliability was similar for junior (κ = 0.78) and senior (κ = 0.71) surgeons. G2: Junior/senior surgeons agreed completely (58%/62%), partially (24%/23%), or did not agree (18%/15%) with the 7LC choice. G3: junior/senior surgeons agreed completely (50%/50%) or partially (50%/50%) with the 7LC choice.
Conclusion The 7LC showed good overall reliability. Junior surgeons went through a learning curve and converged to senior surgeons in the second read. The 7LC helps less experienced surgeons to analyze, in a structured manner, the relevant clinical and imaging parameters influencing the choice of the surgical approach, rather than simply pointing out the only correct one.
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The neurogenic tumor of frequent occurrence in the presacral area is a schwannoma. Giant presacral schwannoma has a risk for anterior surgical approach because of its massive size and proximity to abundant vascularity of presacral region. We report a single stage posterior approach for total resection of a giant presacral schwannoma. A 40-year-old female patient experienced left buttock pain and tingling sensation at left S1 dermatome. Magnetic resonance imaging showed that the presacral huge mass at S1-3 level with osseous extension and structural remodeling in left sacral ala. The presacral mass was ranging in maximum diameter from 8.0 to 8.6cm. S2 foramen laminectomy was performed to expose the mass. The tumor capsule and the root were carefully dissected away. The tumor was removed while preserving the capsule by dissecting the plane between the inner wall of the capsule and the tumor. The single stage posterior approach for presacral giant schwannoma is feasible, and it can be a good surgical alternative to prevent pelvic organ or vascular damage and anterior approach related dystocia and infertility.
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OBJECTIVE Surgical approaches to unstable burst fractures of the thoracolumbar spine are variable and include anterior decompression with interbody fusion and fixation, anterolateral approach and posterior approach. The purpose of this study is to compare the clinical and radiological results of single-stage interbody fusion with transpedicular screw fixation and pedicle screw fixation with lamina onlay fusion. METHODS Thirty-five patients with thoracolumbar burst fractures were enrolled in the present study. The subject group was composed of 21 men and 14 women, with a mean age of 47.68+/-13.93 years(range, 19~76 years). Eighteen patients(Group I, anterior-posterior group) were treated with interbody fusion with transpedicular screw fixation with and 17 patients(Group II, posterior only group) were treated with pedicle screw fixation with onlay fusion. Both procedures were performed through single staged posterior approach. The neurological states, clinical outcomes and radiological outcomes were analyzed. Radiologic results were evaluated on the basis of kyphotic angle, percentage of anterior body compression and interbody height immediately after surgery and at the final follow-up examination. RESULTS Kyphotic angle, anterior body compression rate and interbody height were corrected in both groups. While the correction was maintained in the patients in group I, kyphosis and anterior body compression rate were aggravated in the patients in group II at follow-up. Both groups showed the same or improved modified Frankel grades and pain scores. CONCLUSIONS Group I showed better correction of kyphotic angle and percentage of anterior body compression than group II. Anterior column support plays an important role in maintaining the correction of kyphosis and this procedure can be effectively performed using single-stage unilateral posterior approach together with transpedicular screw fixation.
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