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Radiographic and clinical assessment on the accuracy and complications of C1 anterior lateral mass and C2 anterior pedicle screw placement in the TARP-III procedure: a study of 106 patients

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Abstract

Purpose

To investigate the (1) radiographic and clinical accuracy of C1 anterior lateral mass screw (C1ALMS) and C2 anterior pedicle screw (C2APS) placement in the transoral atlantoaxial reduction plate (TARP)-III procedure, (2) screw insertion-associated clinical complications and (3) fusion status between C1 and C2.

Methods

Radiographic and clinical data were obtained from the electronic medical record system. Studies were carried out to assess the accuracy of C1ALMS and C2APS placement, the screw insertion-associated clinical complications and the fusion status between C1 and C2. Placement of the screws was assessed using the modified All India Institute of Medical Sciences outcome-based classification.

Results

Two-hundred and twelve C1ALMS and 207 C2APS in 106 patients were assessed. The ideal accurate rates were 92.0 % (195) and 53.1 % (110), and the acceptable accurate rates were 97.6 % (207) and 87.0 % (180), respectively. One patient died postoperatively due to C2 screw misplacement. There were no symptoms of neurologic and vertebral artery injuries in the rest of the patients. 102 patients (97.1 %) achieved solid fusion between C1 and C2. No instrumentation failure due to delayed union or nonunion was observed.

Conclusion

C1ALMS placement in TARP-III procedures appears to be safe. The cortical breach rate of C2APS is high though clinically the neurovascular complication rate is similar to that of posterior atlantoaxial procedures. Advanced navigation strategies may help improve the accuracy of C2APS placement and decrease potential complications.

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Acknowledgments

Grants provided by Key Project of the Twelfth Five-year Project of Military Medicine (BWS11C065) and Science and Technology Project of Guangdong Province (2012B031800187).

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Authors and Affiliations

  1. Southern Medical University, Guangzhou, 510515, China

    Xueshi Li

  2. The Department of Orthopedics, Liuhuaqiao Hospital, 111 Liuhua Road, Guangzhou, 510010, China

    Fuzhi Ai, Hong Xia, Zenghui Wu, Xiangyang Ma & Qingshui Yin

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  1. Xueshi Li
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  2. Fuzhi Ai
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  3. Hong Xia
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  4. Zenghui Wu
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Corresponding author

Correspondence to Qingshui Yin.

Additional information

X. Li and F. Ai contributed equally to this work.

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Li, X., Ai, F., Xia, H. et al. Radiographic and clinical assessment on the accuracy and complications of C1 anterior lateral mass and C2 anterior pedicle screw placement in the TARP-III procedure: a study of 106 patients. Eur Spine J 23, 1712–1719 (2014). https://doi.org/10.1007/s00586-014-3353-4

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  • DOI: https://doi.org/10.1007/s00586-014-3353-4

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