The feasibility of inserting a C1 pedicle screw in patients with ponticulus posticus: a retrospective analysis of eleven patients View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2016-05-31

AUTHORS

Xin-Liang Zhang, Da-Geng Huang, Xiao-Dong Wang, Jin-Wen Zhu, Yi-Bing Li, Bao-Rong He, Ding-Jun Hao

ABSTRACT

BackgroundPonticulus posticus is a common anatomic variation that can be mistaken for a broad posterior arch during C1 pedicle screw placement. When the atlas lateral mass screws are placed via the posterior arch, injury to the vertebral artery may result. To our knowledge, there are few clinical studies that have analyzed the feasibility of C1 pedicle screw fixation in patients with ponticulus posticus, in clinical practice.PurposeTo evaluate the feasibility of inserting a C1 pedicle screw in patients with ponticulus posticus.MethodsBetween January 2008 and January 2012, 11 consecutive patients with atlantoaxial instability, and with a ponticulus posticus at C1, underwent posterior fusion surgery in our institution. According to preoperative computed tomography (CT) reconstruction, a complete ponticulus posticus was found unilaterally in nine patients and bilaterally in two. Postoperative CT reconstructive imaging was performed to assess whether C1 pedicle screw placement was successful. Patients were followed up at regular intervals and evaluated for symptoms of ponticulus posticus syndrome.ResultsThirteen C1 pedicles (atlas vertebral artery groove), each with a complete ponticulus posticus, were successfully inserted with thirteen 3.5- or 4.0-mm diameter pedicle screws, without resection of the bony anomaly. No intraoperative complications (venous plexus, vertebral artery, or spinal cord injury) occurred. The mean follow-up period was 21 (range 14–30) months. Postoperative CT reconstructive images showed that all 13 pedicle screws were inserted in the C1 pedicles without destruction of the atlas pedicle cortical bone. In the follow-up period, none of the patients demonstrated clinical symptoms of ponticulus posticus syndrome or developed bone fusion.ConclusionThree-dimensional CT imaging should be considered prior to C1 pedicle screw fixation in patients with ponticulus posticus, to avoid mistaking the ponticulus posticus for a widened dorsal arch of the atlas. If there is no ponticulus posticus syndrome preoperatively, C1 pedicle screw fixation can be successfully performed without removing the bony anomaly. More... »

PAGES

1058-1063

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00586-016-4589-y

DOI

http://dx.doi.org/10.1007/s00586-016-4589-y

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1003398111

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/27246351


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