Salvage posterior atlantoaxial fixation techniques: A retrospective study / Técnicas de fijación atlantoaxial posterior de rescate: un estudio retrospectivo

Object Since the atlantoaxial region have critical neurovascular anatomy and limited bone surface for fusion, the application and choice of salvage fixation techniques are highly important. To discuss alternative posterior atlantoaxial fixation surgery techniques. Methods We retrospectively surgical records of 22 patients that posterior atlantoaxial fixation techniques were applied. Results The patients included 11 males and 11 females (mean age: 65.7 years). The fracture type that caused instability is type 2 odontoid fractures (22). In six of these patients alternative stabilization techniques were applied due to anatomical variations, huge venous bleeding and iatrogenic trauma of the screw entry points during surgery. Conclusions Owing to anatomical variations, intraoperative challenges, and/or instrumentation failures, performing alternative surgical fixation technique is an important factor that affects the success of stabilization of the atlantoaxial region. Knowledge of salvage techniques especially during the learning curve is vitally important. Surgeons should adapt to intraoperative surgical challenges as required (AU)

Objetivo Dado que la región atlantoaxial tiene una anatomía neurovascular crítica y una superficie ósea limitada para la fusión, la elección y la aplicación de las técnicas de fijación de rescate son muy importantes. El objetivo de este estudio es describir técnicas alternativas de cirugía de fijación atlantoaxial posterior. Métodos Realizamos retrospectivamente registros quirúrgicos de 22 pacientes a los que se les aplicaron técnicas de fijación atlantoaxial posterior. Resultados Entre los pacientes se incluyeron 11 varones y 11 mujeres (edad media: 65,7 años). El tipo de fractura que causó inestabilidad fue la fractura de odontoides tipo 2 (22). En seis de estos pacientes se aplicaron técnicas alternativas de estabilización debido a variaciones anatómicas, sangrado venoso considerable y trauma iatrogénico en los puntos de entrada del tornillo durante la cirugía. Conclusiones Debido a variaciones anatómicas, dificultades intraoperatorias y/o fallas de instrumentación, la realización de una técnica de fijación quirúrgica alternativa es un factor importante que afecta el éxito de la estabilización de la región atlantoaxial. Conocer las técnicas de salvamento, especialmente durante la curva de aprendizaje, es de vital importancia. Los cirujanos deben adaptarse a los desafíos quirúrgicos intraoperatorios, según sea necesario (AU)

Salvage posterior atlantoaxial fixation techniques: A retrospective study.

OBJECT: Since the atlantoaxial region have critical neurovascular anatomy and limited bone surface for fusion, the application and choice of salvage fixation techniques are highly important. To discuss alternative posterior atlantoaxial fixation surgery techniques. METHODS: We retrospectively surgical records of 22 patients that posterior atlantoaxial fixation techniques were applied. RESULTS: The patients included 11 males and 11 females (mean age: 65.7 years). The fracture type that caused instability is type 2 odontoid fractures (22). In six of these patients alternative stabilization techniques were applied due to anatomical variations, huge venous bleeding and iatrogenic trauma of the screw entry points during surgery. CONCLUSIONS: Owing to anatomical variations, intraoperative challenges, and/or instrumentation failures, performing alternative surgical fixation technique is an important factor that affects the success of stabilization of the atlantoaxial region. Knowledge of salvage techniques especially during the learning curve is vitally important. Surgeons should adapt to intraoperative surgical challenges as required.