Department of Neurooncology, N. N. Burdenko National Scientific and Practical Center for Neurosurgery, Moscow, Russia.
Department of Vertebrology, N. N. Priorov Central Institute of Traumatology and Orthopedics, Moscow, Russia.
World Neurosurg. 2018 Jan;109:e155-e163. doi: 10.1016/j.wneu.2017.09.124. Epub 2017 Sep 27.
Surgical treatment of patients with atlantoaxial instability caused by pathologic changes of the skull base and craniovertebral junction combined with anterior compression of the brain stem is still associated with substantial technical difficulties and remains a matter of debate. Currently, anterior stabilization of the atlantoaxial junction is a promising approach that allows for the resection of the pathologic lesion of the skull base and craniovertebral junction with subsequent stabilization of C1-C2 or C1-C3 in 1 stage.
In this article, we present 5 clinical cases in which transoral decompression and anterior stabilization of the C1-C2 (4 cases) and C1-C3 (1 case of anteroposterior stabilization) segments with custom-made fixation systems was used to treat various pathologic conditions of the craniovertebral junction.
In all cases, complete removal of the pathologic lesion and decompression of the upper cervical spinal cord as well as reliable stabilization of the upper spinal segments were achieved. Some degree of movement in the cervical spine was preserved in all patients due to unfixed C0-C1 and C3-C7 segments in 4 cases and C0-C1 and C4-C7 in 1 case. Implant migration or instability was not observed in any of the cases. The follow-up period was from 1 to 4 years after surgery.
The first experience of anterior fixation using individually manufactured C1-C2 and C1-C3 systems demonstrated their effectiveness. This approach can be safely used as an alternative or in combination with standard posterior stabilization methods. An innovative surgical technology developed and implemented in our surgical practice allows for optimization of the surgical technique, reduces the number of perioperative complications, eliminates movement restrictions in the cervical spine, improves motor activity, and makes earlier patient rehabilitation possible.
颅底和颅颈交界区病变合并脑干前方受压的寰枢椎不稳患者的手术治疗仍存在较大的技术难度，目前仍存在争议。目前，寰枢椎前路固定是一种有前途的方法，可以在一期内切除颅底和颅颈交界区的病变，并随后稳定 C1-C2 或 C1-C3。
本文介绍了 5 例经口减压和前路 C1-C2（4 例）和 C1-C3（1 例前后路联合固定）节段定制固定系统治疗颅颈交界区各种病变的临床病例。
所有病例均达到了完全切除病变、解除上颈髓压迫和可靠固定上颈椎段的目的。由于 4 例患者 C0-C1 和 C3-C7 段未固定，1 例患者 C0-C1 和 C4-C7 段未固定，所有患者颈椎均保留了一定程度的活动度。所有病例均未发生植入物迁移或不稳定。术后随访 1 至 4 年。
使用个体化 C1-C2 和 C1-C3 系统进行前路固定的初步经验证明了其有效性。该方法可作为标准后路稳定方法的替代方法或联合应用。我们在手术实践中开发和实施的创新性手术技术可优化手术技术，减少围手术期并发症的发生，消除颈椎活动受限，改善运动功能，使患者更早康复。
