Lin Mao-Shih, Huang Chih-Wei, Tsou Hsi-Kai, Tzeng Chung-Yuh, Kao Ting-Hsien, Lin Ruei-Hong, Chen Tse-Yu, Li Chi-Ruei, Lee Cheng-Ying
Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
Int J Rheum Dis. 2023 Oct;26(10):1996-2006. doi: 10.1111/1756-185X.14855. Epub 2023 Aug 11.
An estimated 88% of rheumatoid arthritis (RA) patients experience various degrees of cervical spine involvement. The excessive movement of the atlantoaxial joint, which connects the occiput to the upper cervical spine, results in atlantoaxial instability (AAI). AAI stabilization is usually achieved by C1 lateral mass-to-C2 pedicle screw-rod fixation (LC1-PC2 fixation), which is technically challenging in RA patients who often show destructive changes in anatomical structures. This study aimed to analyze the clinical results and operative experiences of C1-C2 surgery, with emphasis on the advancement of image-guided surgery and augmented reality (AR) assisted navigation.
We presented our two decades of experience in the surgical management of AAI from April 2004 to November 2022.
We have performed surgery on 67 patients with AAI, including 21 traumatic odontoid fractures, 20 degenerative osteoarthritis, 11 inflammatory diseases of RA, 5 congenital anomalies of the os odontoideum, 2 unknown etiologies, 2 movement disorders, 2 previous implant failures, 2 osteomyelitis, 1 ankylosing spondylitis, and 1 tumor. Beginning in 2007, we performed LC1-PC2 fixation under C-arm fluoroscopy. As part of the progress in spinal surgery, since 2011 we used surgical navigation from presurgical planning to intraoperative navigation, using the preoperative computed tomography (CT) -based image-guided BrainLab navigation system. In 2021, we began using intraoperative CT scan and microscope-based AR navigation.
The technical complexities of C1-C2 surgery can be mitigated by CT-based image-guided surgery and microscope-based AR navigation, to improve accuracy in screw placement and overall clinical outcomes, particularly in RA patients with AAI.
估计88%的类风湿关节炎（RA）患者会出现不同程度的颈椎受累。连接枕骨与上颈椎的寰枢关节过度活动会导致寰枢椎不稳（AAI）。AAI的稳定通常通过C1侧块至C2椎弓根螺钉-棒固定（LC1-PC2固定）来实现，而这在解剖结构常出现破坏改变的RA患者中技术难度较大。本研究旨在分析C1-C2手术的临床结果和手术经验，重点关注图像引导手术和增强现实（AR）辅助导航技术的进展。
我们介绍了2004年4月至2022年11月期间在AAI手术治疗方面的二十年经验。
我们对67例AAI患者进行了手术，包括21例创伤性齿状突骨折、20例退行性骨关节炎、11例RA炎性疾病、5例齿突先天性异常、2例病因不明、2例运动障碍、2例既往植入物失败、2例骨髓炎、1例强直性脊柱炎和1例肿瘤。从2007年开始，我们在C形臂透视引导下进行LC1-PC2固定。作为脊柱手术进展的一部分，自2011年起，我们在术前规划到术中导航过程中使用基于术前计算机断层扫描（CT）的图像引导BrainLab导航系统。2021年，我们开始使用术中CT扫描和基于显微镜的AR导航。
基于CT的图像引导手术和基于显微镜的AR导航可减轻C1-C2手术的技术复杂性，提高螺钉置入的准确性和整体临床效果，尤其是在患有AAI的RA患者中。
