Nội dung được dịch bởi AI, chỉ mang tính chất tham khảo
Những thách thức phẫu thuật trong việc gắn cố định vùng giao lộ cổ-thắt lưng phía sau
Tóm tắt
Vùng giao lộ cổ-thắt lưng (CTJ) là một khu vực của cột sống chịu áp lực cơ học đáng kể. Những đặc điểm giải phẫu và sinh học cơ học đặc biệt khiến cho việc cố định phẫu thuật phía sau của vùng này trở nên đặc biệt khó khăn. Chúng tôi trình bày và thảo luận về loạt phẫu thuật của mình, nhấn mạnh những thách thức phẫu thuật cụ thể mà khu vực này của cột sống mang lại. Chúng tôi đã phân tích và báo cáo dữ liệu hồi cứu từ những bệnh nhân đã trải qua phẫu thuật gắn cố định phía sau vùng giao lộ cổ-thắt lưng từ năm 2011 đến 2019 tại Khoa Ngoại thần kinh của Bệnh viện Đại học Geneva. Chúng tôi đã thảo luận về các kỹ thuật gắn cố định ở C7 và Th1, thiết kế thanh gắn, phạm vi của các cấu trúc và điều hướng cột sống. Sáu mươi sáu bệnh nhân đã được đưa vào nghiên cứu. Chúng tôi đã ưu tiên sử dụng vít khối bên (LM) ở cột sống dưới trục và vít đùi (PS) ở C7, Th1 và phần trên của cột sống ngực. Chúng tôi không tìm thấy sự vượt trội của các kỹ thuật điều hướng 3D so với hướng dẫn fluoroscopy 2D trong độ chính xác của việc đặt PS, có thể do kích thước mẫu nghiên cứu tương đối nhỏ. Nhiễm trùng tại vị trí phẫu thuật là biến chứng phổ biến nhất, có liên quan đáng kể đến chẩn đoán u. Khi có thể về mặt kỹ thuật, PS là kỹ thuật được lựa chọn cho việc gắn cố định C7 và Th1 mặc dù vẫn còn những kỹ thuật an toàn khác có sẵn. Các cấu trúc thanh gắn khác nhau được mô tả, mặc dù những khác biệt đáng kể về độ ổn định sinh học cơ học vẫn cần được làm rõ. Định vị cột sống nên được sử dụng bất cứ khi nào có thể, mặc dù fluoroscopy 2D vẫn là một lựa chọn an toàn. Việc gắn cố định phía sau vùng CTJ là một quy trình đầy thách thức, nhưng với kế hoạch phẫu thuật và kỹ thuật chính xác, nó là an toàn và hiệu quả.
Từ khóa
#giao lộ cổ-thắt lưng #cố định phẫu thuật #sinh học cơ học #điều hướng cột sống #biến chứng phẫu thuậtTài liệu tham khảo
Aydogan M, Enercan M, Hamzaoglu A, Alanay A (2012) Reconstruction of the subaxial cervical spine using lateral mass and facet screw instrumentation. Spine (Phila Pa 1976) 37:E335–E341. https://doi.org/10.1097/BRS.0b013e31824442eb
Bayoumi AB, Efe IE, Berk S, Kasper EM, Toktas ZO, Konya D (2018) Posterior Rigid Instrumentation of C7: Surgical Considerations and Biomechanics at the Cervicothoracic Junction. A Review of the Literature. World Neurosurg 111:216–226. https://doi.org/10.1016/j.wneu.2017.12.026
Bledsoe JM, Fenton D, Fogelson JL, Nottmeier EW (2009) Accuracy of upper thoracic pedicle screw placement using three-dimensional image guidance. Spine J 9:817–821. https://doi.org/10.1016/j.spinee.2009.06.014
Braga BP, de Morais JV, Vilela MD (2010) Free-hand placement of high thoracic pedicle screws with the aid of fluoroscopy: evaluation of positioning by CT scans in a four-year consecutive series. Arq Neuropsiquiatr 68:390–395. https://doi.org/10.1590/s0004-282x2010000300012
Bueff HU, Lotz JC, Colliou OK, Khapchik V, Ashford F, Hu SS, Bozic K, Bradford DS (1995) Instrumentation of the cervicothoracic junction after destabilization. Spine (Phila Pa 1976) 20:1789–1792. https://doi.org/10.1097/00007632-199508150-00007
Cecchinato R, Berjano P, Zerbi A, Damilano M, Redaelli A, Lamartina C (2019) Pedicle screw insertion with patient-specific 3D-printed guides based on low-dose CT scan is more accurate than free-hand technique in spine deformity patients: a prospective, randomized clinical trial. Eur Spine J 28:1712–1723. https://doi.org/10.1007/s00586-019-05978-3
Cheng I, Sundberg EB, Iezza A, Lindsey DP, Riew KD (2015) Biomechanical Determination of Distal Level for Fusions across the Cervicothoracic Junction. Glob Spine J 5:282–286. https://doi.org/10.1055/s-0035-1546418
Clifton W, Louie C, Williams DB, Damon A, Dove C, Pichelmann M (2019) Safety and accuracy of the freehand placement of C7 pedicle screws in cervical and cervicothoracic constructs. Cureus 11(8):e5304. https://doi.org/10.7759/cureus.5304
DalCanto RA, Lieberman I, Inceoglu S, Kayanja M, Ferrara L (2005) Biomechanical comparison of transarticular facet screws to lateral mass plates in two-level instrumentations of the cervical spine. Spine (Phila Pa 1976) 30:897–892. https://doi.org/10.1097/01.brs.0000158937.64577.25
Daniels AH, Reid DBC, Durand WM, Hamilton DK, Passias PG, Kim HJ, Protopsaltis TS, Lafage V, Smith JS, Shaffrey CI, Gupta M, Klineberg E, Schwab F, Burton D, Bess S, Ames CP, Hart RA (2020) Upper-thoracic versus lower-thoracic upper instrumented vertebra in adult spinal deformity patients undergoing fusion to the pelvis: Surgical decision-making and patient outcomes. J Neurosurg Spine 32:600–606. https://doi.org/10.3171/2019.9.SPINE19557
Desai S, Sethi A, Ninh CC, Bartol S, Vaidya R (2010) Pedicle screw fixation of the C7 vertebra using an anteroposterior fluoroscopic imaging technique. Eur Spine J 19:1953–1959. https://doi.org/10.1007/s00586-010-1513-8
Du JP, Wang DH, Zhang J, Fan Y, Wu QN, Hao DJ (2018) Accuracy of pedicle screw insertion among 3 image-guided navigation systems: systematic review and meta-analysis. World Neurosurg 109:24–30
Dunlap BJ, Karaikovic EE, Park H-S, Sokolowski MJ, Zhang L-Q (2010) Load sharing properties of cervical pedicle screw-rod constructs versus lateral mass screw-rod constructs. Eur Spine J 19:803–808. https://doi.org/10.1007/s00586-010-1278-0
Eleraky M, Setzer M, Baaj AA, Papanastassiou I, Conrad BP, Vrionis FD (2010) Biomechanical comparison of posterior cervicothoracic instrumentation techniques after one-level laminectomy and facetectomy. J Neurosurg Spine 13:622–629. https://doi.org/10.3171/2010.5.SPINE09848
Fayed I, Toscano DT, Triano MJ, Makariou E, Lee C, Spitz SM, Anaizi AN, Nair MN, Sandhu FA, Voyadzis J-M (2020) Crossing the cervicothoracic junction during posterior cervical decompression and fusion: is it necessary? Neurosurgery 86:544–550. https://doi.org/10.1093/neuros/nyaa078
Fernandes Joaquim A, Mudo ML, Tan LA, Riew KD (2020) Posterior subaxial cervical spine screw fixation: a review of techniques. J Spine Surg 6(1):252–261. https://doi.org/10.1177/2192568218759940
Gertzbein S, Robbins S (1990) Accuracy of pedicular screw placement in vivo. Spine (Phila Pa 1976) 15:11–14. https://doi.org/10.1097/00007632-199001000-00004
Godzik J, Dalton JF, Martinez-del-Campo E, Newcomb AGUS, Dominguez F, Reyes PM, Theodore N, Kelly BP, Crawford NR (2019) Biomechanical evaluation of cervicothoracic junction fusion constructs. World Neurosurg 124:e139–e146. https://doi.org/10.1016/j.wneu.2018.12.040
Heller JG, Carlson GD, Abitbol JJ, Garfin SR (1991) Anatomic comparison of the Roy-Camille and Magerl techniques for screw placement in the lower cervical spine. Spine (Phila Pa 1976) 16:S552–S557. https://doi.org/10.1097/00007632-199110001-00020
Hilibrand AS, Robbins M (2004) Adjacent segment degeneration and adjacent segment disease: The consequences of spinal fusion? Spine J 4:S190–S194. https://doi.org/10.1016/j.spinee.2004.07.007
Hong JT, Tomoyuki T, Jain A, Orías AAE, Inoue N, An HS (2017) Which salvage fixation technique is best for the failed initial screw fixation at the cervicothoracic junction? A biomechanical comparison study. Eur Spine J 26:2417–2424. https://doi.org/10.1007/s00586-017-5239-8
Huang KT, Harary M, Abd-El-Barr MM, Chi JH (2019) Crossing the Cervicothoracic Junction in Posterior Cervical Decompression and Fusion: A Cohort Analysis. World Neurosurg 131:e514–e520. https://doi.org/10.1016/j.wneu.2019.07.219
Hyun S-J, Lee BH, Park J-H, Kim K-J, Jahng T-A, Kim H-J (2017) Proximal junctional kyphosis and proximal junctional failure following adult spinal deformity surgery. Korean J Spine 14:126–132. https://doi.org/10.14245/kjs.2017.14.4.126
Ibaseta A, Rahman R, Andrade NS, Uzosike AC, Byrapogu VK, Ramji AF, Skolasky RL, Reidler JS, Kebaish KM, Riley LH, Sciubba DM, Cohen DB, Neuman BJ (2019) Crossing the cervicothoracic junction in cervical arthrodesis results in lower rates of adjacent segment disease without affecting operative risks or patient-reported outcomes. Clin Spine Surg 32:377–381. https://doi.org/10.1097/BSD.0000000000000897
Jeanneret B, Magerl F, Ward EH, Ward JC (1991) Posterior stabilization of the cervical spine with hook plates. Spine (Phila Pa 1976) 16:S56–S63. https://doi.org/10.1097/00007632-199103001-00010
Jenkins AL, Singh H, Meyer SA, Hecht AC (2009) Novel fluoroscopic technique for localization at cervicothoracic levels. J Spinal Disord Tech 22:615–618. https://doi.org/10.1097/BSD.0b013e31818da7ce
Kaya RA, Türkmenoǧlu ON, Koç ÖN, Genç HA, Çavuçoǧlu H, Ziyal IM, Aydin Y (2006) A perspective for the selection of surgical approaches in patients with upper thoracic and cervicothoracic junction instabilities. Surg Neurol 65:454–463. https://doi.org/10.1016/j.surneu.2005.08.017
Kim HJ, Lenke LG, Shaffrey CI, Van Alstyne EM, Skelly AC (2012) Proximal junctional kyphosis as a distinct form of adjacent segment pathology after spinal deformity surgery: a systematic review. Spine (Phila. Pa. 1976) 15;37(22 Suppl):S144–64. https://doi.org/10.1097/BRS.0b013e31826d611b
Kreshak JL, Kim DH, Lindsey DP, Kam AC, Panjabi MM, Yerby SA (2002) Posterior stabilization at the cervicothoracic junction: A biomechanical study. Spine (Phila Pa 1976) 27:2763–2770. https://doi.org/10.1097/00007632-200212150-00005
Kulkarni AG, Dhruv AN, Bassi AJ (2015) Posterior cervicothoracic instrumentation, testing the clinical efficacy of tapered rods (Dual-Diameter Rods). J Spinal Disord Tech 28:382–388. https://doi.org/10.1097/bsd.0000000000000133
Kumar S, van Popta D, Rodrigues-Pinto R, Stephenson J, Mohammad S, Siddique I, Verma RR (2015) Risk factors for wound infection in surgery for spinal metastasis. Eur Spine J 24:528–532. https://doi.org/10.1007/s00586-013-3127-4
Lee DH, Cho JH, Jung JI, Baik JM, Jun DS, Hwang CJ, Lee CS (2019) Does stopping at C7 in long posterior cervical fusion accelerate the symptomatic breakdown of cervicothoracic junction? PLoS One 14:1–10. https://doi.org/10.1371/journal.pone.0217792
Lee DH, Lee SW, Kang SJ, Hwang CJ, Kim NH, Bae JY, Kim YT, Lee CS, Daniel Riew K (2011) Optimal entry points and trajectories for cervical pedicle screw placement into subaxial cervical vertebrae. Eur Spine J 20:905–911. https://doi.org/10.1007/s00586-010-1655-8
Lehman RA, Polly DW, Kuklo TR, Cunningham B, Kirk KL, Belmont PJ (2003) Straight-forward Versus anatomic trajectory technique of thoracic pedicle screw fixation: A biomechanical analysis. In: Spine. pp 2058–2065
Little AS, Brasiliense LBC, Lazaro BCR, Reyes PM, Dickman CA, Crawford NR (2010) Biomechanical comparison of costotransverse process screw fixation and pedicle screw fixation of the upper thoracic spine. Oper Neurosurg 66:ons178–ons182. https://doi.org/10.1227/01.neu.0000350869.35779.05
Roy-Camille R, Mazel C, Saillant G (1987) Treatment of cervical spine injuries by a posterior osteosynthesis with plates and screws. In: Kehr P, Weidner A (eds) Cervical spine I: Strasbourg 1985. Springer Vienna, Vienna, pp 163–174. https://doi.org/10.1007/978-3-7091-8882-8_29
McGirt MJ, Sutter EG, Xu R, Sciubba DM, Wolinsky J-P, Witham TF, Gokaslan ZL, Bydon A (2009) Biomechanical comparison of translaminar versus pedicle screws at T1 and T2 in long subaxial cervical constructs. Neurosurgery 65:167–172; discussion 172. https://doi.org/10.1227/01.NEU.0000345642.50726.A3
Rienmüller A, Buchmann N, Kirschke JS, Meyer EL, Gempt J, Lehmberg J, Meyer B, Ryang YM (2017) Accuracy of CT-navigated pedicle screw positioning in the cervical and upper thoracic region with and without prior anterior surgery and ventral plating. Bone Jt J 99B:1373–1380. https://doi.org/10.1302/0301-620X.99B10.BJJ-2016-1283.R1
Schatlo B, Molliqaj G, Cuvinciuc V, Kotowski M, Schaller K, Tessitore E (2014) Safety and accuracy of robot-assisted versus fluoroscopy-guided pedicle screw insertion for degenerative diseases of the lumbar spine: a matched cohort comparison - Clinical article. J Neurosurg Spine 20:636–643. https://doi.org/10.3171/2014.3.SPINE13714
Scheufler KM, Franke J, Eckardt A, Dohmen H (2011) Accuracy of image-guided pedicle screw placement using intraoperative computed tomography-based navigation with automated referencing, part I: Cervicothoracic spine. Neurosurgery 69:782–795. https://doi.org/10.1227/NEU.0b013e318222ae16
Schroeder GD, Kepler CK, Kurd MF, Mead L, Millhouse PW, Kumar P, Nicholson K, Stawicki C, Helber A, Fasciano D, Patel AA, Woods BI, Radcliff KE, Rihn JA, Greg Anderson D, Hilibrand AS, Vaccaro AR (2016) Is it necessary to extend a multilevel posterior cervical decompression and fusion to the upper thoracic Spine? Spine (Phila Pa 1976) 41:1845–1849. https://doi.org/10.1097/BRS.0000000000001864
Stemper BD, Marawar SV, Yoganandan N, Shender BS, Rao RD (2008) Quantitative anatomy of subaxial cervical lateral mass: An analysis of safe screw lengths for Roy-Camille and Magerl techniques. Spine (Phila Pa 1976) 33:893–897. https://doi.org/10.1097/BRS.0b013e31816b4666
Takayasu M, Hara M, Yamauchi K, Yoshida M, Yoshida J (2003) Transarticular screw fixation in the middle and lower cervical spine. Technical note. J Neurosurg 99:132–136. https://doi.org/10.3171/spi.2003.99.1.0132
Tessitore E, El-Hassani Y, Schaller K (2011) How i do it: Cervical lateral mass screw fixation. Acta Neurochir 153:1695–1699. https://doi.org/10.1007/s00701-011-1068-4
Tian NF, Huang QS, Zhou P, Zhou Y, Wu RK, Lou Y, Xu HZ (2011) Pedicle screw insertion accuracy with different assisted methods: A systematic review and meta-analysis of comparative studies. Eur Spine J 20:846–859
Walker CT, Kakarla UK, Chang SW, Sonntag VKH (2019) History and advances in spinal neurosurgery. J Neurosurg Spine 31:775–785. https://doi.org/10.3171/2019.9.SPINE181362
Wang VY, Chou D (2007) The cervicothoracic junction. Neurosurg Clin N Am 18:365–371. https://doi.org/10.1016/j.nec.2007.02.012
Welke B, Schwarze M, Hurschler C, Nebel D, Bergmann N, Daentzer D (2018) In vitro investigation of two connector types for continuous rod construct to extend lumbar spinal instrumentation. Eur Spine J 27:1895–1904. https://doi.org/10.1007/s00586-018-5664-3
Xu R, Ebraheim NA, Ou Y, Skie M, Yeasting RA (2000) Anatomic considerations of costotransverse screw placement in the thoracic spine. Surg Neurol 53(4):349–354; discussion 354–5. https://doi.org/10.1016/s0090-3019(00)00203-2
Yang JS, Buchowski JM, Verma V (2015) Construct type and risk factors for pseudarthrosis at the cervicothoracic junction. Spine (Phila Pa 1976) 40:E613–E617. https://doi.org/10.1097/BRS.0000000000000868