Screw placement guided by C-arm computer navigation in atlantoaxial pedicle screw fixation and fusion of atlantoaxial instability
10.3760/cma.j.cn115530-20240702-00278
- VernacularTitle:C型臂计算机导航引导下置钉在椎弓根螺钉固定融合术治疗寰枢椎不稳定中的应用
- Author:
Xu LIAN
1
;
Weiwei ZHOU
1
;
Zhinan REN
1
;
Lei YU
1
;
Guangduo ZHU
1
;
Jing ZHANG
1
;
Yingjie HAO
1
Author Information
1. 郑州大学第一附属医院骨科，郑州 450052
- Publication Type:Journal Article
- Keywords:
Atlanto-axial joint;
Joint instability;
Fluoroscopy;
Spinal fusion;
Computerized navigation;
Pedicle screws
- From:
Chinese Journal of Orthopaedic Trauma
2024;26(12):1019-1026
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the screw placement guided by C-arm computer navigation in the fixation and fusion of instability of the atlantoaxial joint using atlantoaxial pedicle screws.Methods:A retrospective study was conducted to analyze the clinical data of 30 patients who had been treated for atlantoaxial instability by pedicle screw fixation and fusion at Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University from October 2020 to November 2022. The patients were divided into 2 groups according to whether the C-arm computer navigation system had been used to assist their screw placement. In the observation group, there were 12 patients [9 males and 3 females with an age of (55.6±7.3) years] whose screw placement was assisted by C-arm computer navigation; in the control group, there were 18 patients [13 males and 5 females with an age of (52.4±8.1) years] whose screw placement was assisted by conventional X-ray fluoroscopy. The 2 groups were compared in terms of surgery time, intraoperative bleeding volume, intraoperative fluoroscopy time, incidence of postoperative complications, and neck disability index (NDI) and visual analogue scale (VAS) at 3 months after surgery.Results:The 2 groups were comparable because there were no significant differences in the preoperative general data between them ( P>0.05). All the 30 patients were followed up for (23.8±6.1) months after surgery. The surgery time, intraoperative fluoroscopy time, and intraoperative bleeding volume in the observation group were significantly shorter or smaller, respectively, than those in the control group [(109.5±19.3) min versus (135.6±23.2) min; (43.5±11.7) s versus (68.8±24.5) s; (240.6±65.8) mL versus (320.4±95.6) mL)] ( P<0.05). No vascular or neural injuries or other complications occurred in any of the patients. There was no statistically significant difference between the observation group and the control group in the NDI or VAS pain score at 3 months after surgery [(18.6±7.3) points versus (20.4±9.3) points; (1.6±0.6) points versus (1.4±0.5) points] ( P>0.05). Follow-ups observed no loosening or breakage of implants, no recurrence of instability of the atlantoaxial joint, or no nonunion of the bone grafts. Conclusion:In the treatment of atlantoaxial instability with atlantoaxial pedicle screw fixation and fusion, compared with conventional X-ray fluoroscopy guidance, the screw placement guided by C-arm computer navigation can result in the same therapeutic efficacy but shorter surgery time, less intraoperative blood loss and less radiation exposure.
