European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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Evaluate the accuracy of five different techniques for lower cervical pedicle screw placement. ⋯ Blind screw placement was surely unsafe. Lower cervical pedicle screw placement assisted by the CT-based navigation system or the Iso-C 3D navigation system significantly improved the accuracy compared to the fluoroscopy assistance and the virtual fluoroscopy navigation assistance.
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Case Reports
Transarticular fusion for treatment of cystic lesion arising from an odontoid fracture.
Odontoid fractures are the most common upper cervical spine fracture. There are two mechanisms in which odontoid fractures occur, most commonly hyperflexion of the neck resulting in displacement of the dens anteriorly and hyperextension resulting in posterior dens displacement. Type 2 fractures are the most common and are associated with significant non-union rates after treatment. One possible consequence of an odontoid fracture is a synovial cyst, resulting in spinal cord compression, presenting as myelopathy or radiculopathy. Synovial cysts as a result of spinal fracture, usually of the facet joint, are most common in the lumbar region, followed by the thoracic and then cervical region; cervical cysts are rare. Fracture and subsequent cyst formation is thought to be related to hyper-motion or trauma of the spine. This is reinforced by the appearance of spinal synovial cysts most commonly at the level of L4/5; this being the region with the biggest weight-bearing function. The most common site of cervical cyst formation is at the level of C7/T1; this is a transitional joint subjected to unique stress and mechanical forces not present at higher levels. Treatment of a cervical synovial cyst at the level of the odontoid is challenging with little information available in the literature. The majority of cases appear to implement posterior surgical resection of the cyst, with fusion of adjacent cervical vertebrae to stabilise the fracture, resulting in restricted range of movement. ⋯ Minimal invasive surgery of C1/C2 transarticular fusion was successfully performed resulting in significant improvement of neurological symptoms in this patient. At 1-year follow-up, the cyst had resolved without surgical removal and this was confirmed by radiological measures.
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To evaluate the clinical study efficacy and feasibility of 11 children with tuberculosis of the upper cervical spine treated by one-stage posterior debridement, short-segment fusion, and posterior instrumentation. ⋯ One-stage posterior debridement, short-segment fusion, and posterior instrumentation can be an effective treatment method for the treatment of tuberculosis of the upper cervical spine in children.
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This study describes a percutaneous technique for C2 transpedicular screw fixation and evaluates its safety and efficacy in the treatment of patients with hangman's fracture. ⋯ The fluoroscopically assisted percutaneous C2 transpedicular screw fixation method is a technically feasible and minimally invasive technique for hangman's fracture.
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Case Reports
Treatment strategies for severe C1C2 luxation due to congenital os odontoideum causing tetraplegia.
High-grade C1C2 luxation is a rare pathology. There is no clear evidence as to how to treat this deformity. There is only limited evidence about the different surgical techniques and possible approaches including advantages, disadvantages, and complications. ⋯ Treatment of severe C1C2 luxation is difficult with limited evidence in the literature. The current case shows a successful treatment strategy to reduce the deformity and lists alternative approaches.