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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 386 - 386
1 Sep 2012
Josten C Jarvers J Riesner H Franck A Glasmacher S Schmidt C
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Purpose

In stabilisations of atlantoaxial instabilities it holds risks to injure the A. vertebralis as well as neurological structures. Furthermore the posterior approach of the upper part of the cervical spine requires a huge and traumatic preparation of the soft tissue. However the anterior transarticular C1-2 fusion (ATF) is less traumatic and offers almost the same strengh of the stabilisation.

Methods

Since the 01/2007 22 multimorbid patients with atlanto-axial instabilities of different entities were treated via the ATF, were regular examined radiologicaly (x-ray/CT) and the procedure critically judged.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 194 - 195
1 May 2011
Josten C Jarvers J Riesner H Siekmann H Blattert T
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Purpose: The posterior transarticuar screw fixation C1-2 (Magerl) is a demanding procedure to treat atlanto-axial instabilities. In spite of a high primary instability it holds risks to injure the A. vertebralis as well as neurological structures. Furthermore the posterior approach of the upper part of the cervical spine requires a huge and traumatic preparation of the soft tissue. However the anterior transarticular C1-2 fusion is less traumativc and offers approximately the same strengh of the stabilisation.

Methods: Since the beginning of 2007 17 multimorbid patients with atlanto-axial instabilities of different entities were treated via the anterior transarticular fusion, were regular examined radioogicaly (x-ray/CT) and the procedure critically judged.

Results: C1-2 fusions were performed in 17 patients (13f, 4m, average 81,6 years (68.95)). The main symptoms was pain radiating in the upper cervical spine and the occiput, 2 Patients complaining radiating pain with paraesthesia in both upper extremities, whereas the neurology was predoinant inconspicious. The average operation-time took 64,5 min. On the left side the screws of Ø 39,5mm (32–44mm), on the right side of 36mm (32–44mm) were inserted in addiction to the point of access and the angle of insertion (mediolateral angle Ø 32,0°, ventrodorsal Ø17,6°). There were no intraoperative complications concerning the ceratin procedure, postoperative one revision had to be done because of p.o. bleeding, another because of screw dislocation with clinical relevance 21 days after the first operation. The postoperative x-ray and CT control of the upper cervical spine showed 21/34 screws in 17 patients in correct position (61,7%), 7 (20,6%) screws were too long, 6 (17,7%) screws were placed too anterior and too medial compared to the oppinion of literature. position in the literature. 3 additional positionated dens-screws were in correct position. After a clear learning curve both screws of the 6th patient were positoinated correct. In this connection it could be shown, that two aspects are important for success: A correct entry point as well as the right insertion of the angle of the screws in the coronar and sagittal view. A low intraoperative blood loss, a non traumatic access as well as an immediate postoperative pain decrease have to be valued positively for this procedure.

Conclusions: The gentle procedure of the anterior transarticular C1-2 fusion requires-despite of the huge experience in anterior surgery of dens fractures – a learning curve, because of the more proximate insertion point, the flat insertion angle and the closeness of the A. vertebralis. If these aspects are going to be noticed, failed screw positioning and excessive length as well as injuries of the A. vertebralis can be avoided.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_IV | Pages 562 - 562
1 Oct 2010
Blattert T Josten C Katscher S Riesner H Siekmann H Stockmar C
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Introduction: In kyphoplasty and vertebroplasty, polymethyl methacrylate (PMMA) is currently the standard in augmentation materials but it is characterized by a lack of osseointegration and limited biocompatibility. At the same time, calcium phosphate cements are not currently considered an alternative due to their insufficient mechanical stability against shear, compression and extension forces. This prospective study examines the suitability of a new calcium alumiate ceramic (Xeraspine®, Doxa) for augmentation of vertebral fractures treated with balloon-kyphoplasty.

Methods: The operation technique follows the standard protocol for a bilateral percutaneous balloon-kypho-plasty (Kyphon). Exclusion criteria were: additional instrumentation, age > 90 years, as well as cardiac arrhythmia. The following clinical and radiological data were collected pre and post op, as well as after 6 weeks: Visual-Analogue-Score, Oswestry-Index, bisegmental endplate angle, and vertebral hight. A CT- scan was provided to show possible cement extrusion and disintegration.

Results: 20 vertebrae were included so far. The fractures could be classified as: type A1.3 (n=11), A3.1 (9). They were located at Th9 - L3. All 20 patients reported pain relief immediately post op. Restoration of endplate angles was 6,2° on average. There was no case of cement disintegration. No loss of correction was observed radiologically.

Discussion: The calcium aluminate ceramic used in balloon-kyphoplasty is an alternative to PMMA. Due to comparable shear, compression and extension strengths, there is no risk of cment breakage and following loss of correction. On the other hand the calcium aluminate ceramic shows better biocompatibility if compared to PMMA.