Minimally invasive instrumentation of uncomplicated cervical fractures.
OBJECTIVE
Many authors favor conservative treatment options in oligo-symptomatic non-dislocated cervical fractures. This is mainly because of adverse events, anesthesia times and blood loss associated with surgical treatment of these injuries. We, therefore, sought to minimize the invasiveness of the surgical treatment of simple cervical fractures using image-guidance and a percutaneous approach.


METHODS
Iso-C3D-based image guidance was used to place unilateral lag screws and conventional screws in pedicles, isthmi and lateral masses C1-C6. The navigation reference marker array was attached to the Mayfield clamp avoiding any additional skin incisions. Drilling of the screws trajectories was performed using a high speed drill with diamond tip, minimizing the risk of dislocations of cervical vertebrae and/or bone fragments relative to the iso-C3D scan to which the navigation system was registered.


RESULTS
Image-guided percutaneous placement of cervical pedicle, isthmic and lateral mass screws resulted in correct screw placement in all six cases (three hangman fractures, three odontoid fracture Anderson 2 in elderly patients and one C6 posttraumatic pedicular pseudoarthrosis). Average blood loss was 194 ml, total average operating time 106 min and average X-ray time 3.8 min (395 cGy/cm(2)) including iso-C3D imaging.


CONCLUSIONS
The technique presented here was found to be a feasible minimally invasive treatment option for uncomplicated cervical fractures. Besides to our best knowledge, we here present the first percutaneous implantation of lateral mass screws.
Department of Neurosurgery, University Medical Centre Mainz, Johannes-Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany. sven.kantelhardt@web.de.
Sven R
SR
Kantelhardt
Department of Neurosurgery, University Medical Centre Mainz, Johannes-Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
Naureen
N
Keric
Department of Neurosurgery, University Medical Centre Mainz, Johannes-Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
Jens
J
Conrad
Department of Neurosurgery, University Medical Centre Mainz, Johannes-Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
Eleftherios
E
Archavlis
Department of Neurosurgery, University Medical Centre Mainz, Johannes-Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
Alf
A
Giese
D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000293:injuries* / Q000601:surgery; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D016103:Spinal Fractures / Q000601:surgery*; D016896:Treatment Outcome
Cervical spine fracture; Image-guidance; Minimal invasive; Navigation; Percutaneous