[C1 lateral mass-C2 pedicle screws and crosslink compression fixation for instable atlas fracture].

OBJECTIVES: To evaluate the feasibility and reliability of C(1) lateral-mass screw-C(2) pedicle screw and crosslink compression fixation for Jefferson fracture. METHODS: Seventeen patients with atlas fracture, 12 males and 5 females, aged 42.5 (25 - 67), 4 of which with unstable atlas fracture, were treated. 11 cases underwent C(1) lateral mass and C(2) pedicle screws and crosslink fixation, 6 of which had axial instability and rupture of atlas transverse ligament, 1 had C(2) luminal fracture, and the other 4 had axial instability. With the assistant of regional anatomy study and fluoroscopy the C(1) lateral mass screw and C(2) pedicle screw were inserted properly. Connecting rods were applied into the two screws on each side. Crosslink between the two rods were applied, compressing to achieve the realignment of the C(1) lateral mass fracture and C(0)-C(1)-C(2) into anatomical position. C(1)-C(2) fusions with posterior bone graft were performed in the patients with axial instability or transverse ligament discontinuity. RESULTS: The operative time ranged from 90 to 176 min with an average of 124 min. The intra-operative blood loss ranged from 270 to 1200 ml with an average of 432 ml. Fluoroscopic examination was used for 18 seconds on average. There were no neurological deficits, vertebral artery related complications or other complications in all the patients. No neurological deficit was aggravated after the patient's mobilization with brace 5 days after operation. One case of vertebral artery rupture happened because of the use of electrocautery. The bleeding was stopped by the use of hemostatic sponge and bone cement without causing cerebral hemodynamic deficit. X-ray examination showed bone fusion and stability in all the patients three months after the operation. The restoration of the C(2) fracture was confirmed by CT scan. CONCLUSION: Osteosynthesis of the atlas by C(1) lateral-mass screw-C(2) pedicle screw and crosslink compression fixation is an ideal option for C(1) burst fracture with or without rupture of transverse ligament. The procedure allows a physiological reconstruction of the C(0)-C(1)-C(2) joint and short segmental solid fusion for Jefferson fracture.

[The efficacy of third-generation instrumentation for the treatment of adult scoliosis].

OBJECTIVE: To evaluate the efficacy of third generation spinal instrumentation such as TSRH, CD and ISOLA for the treatment of adult scoliosis. METHODS: Thirty-five adult scoliosis patients including adult idiopathic and degenerative scoliosis were all surgically treated with third generation instrumentation such as TSRH, CD and ISOLA from July 1999 to January 2003. Preoperative mean cobb angles of major curves of the frontal plane was 58.1 degrees (42 degrees -95 degrees ). The patients received anterior combined with posterior correction or single posterior procedure. Mean follow-up was 20 months (10 - 48 months). Preoperative and postoperative Cobb angles of the frontal plane and sagittal plane and distance between C(7) and CVSL were measured. We assessed the subjective efficacy by questionnaire. RESULTS: Clinical appearance of all patients improved significantly. Mean correction of major curves of the coronal plane was 53.2%. Mean lost of correction of the coronal plane in the last follow-up was 4.3 degrees , distance between the midline of C(7) and CVSL was corrected from 2.6 cm to 0.24 cm. Questionnaire in the follow-up showed that 89.3% patients were satisfied with operation results. Two cases occurred pneumatothorax and haematothorax. Three cases still complained about low back pain in 1 year after operation, among which 2 were adjacent degeneration and 1 was pseudarthrosis. CONCLUSION: Imageology assessment and patients self-evaluation shows that the third generation instrumentation could gain good correction and trunk balance in the treatment for adult scoliosis. And patients are more satisfied and have less complications.