Ono Kosei, Murata Sohei, Matsushita Mutsumi, Shimizu Yu, Nakamura Yusuke, Yabe Taisuke, Ito Hiromu
Department of Orthopedic Surgery, Kurashiki Central Hospital, Okayama, JPN.
Cureus. 2024 Jun 28;16(6):e63422. doi: 10.7759/cureus.63422. eCollection 2024 Jun.
Introduction Surgical treatments for retro-odontoid pseudotumors (ROPs) include C1 laminectomies and C1-2 and occipitocervical (OC) fusions. When a C1 laminectomy is combined with a C1-2 fusion, concerns arise regarding an increased risk of pseudarthrosis due to decreased bone grafting space. Extension of the fusion area to the OC region may be considered to ensure an adequate bone graft bed. However, this procedure is associated with a risk of complications. Thus, in this study, we investigated the bone fusion and clinical outcomes of C1-2 fusion combined with a C1 laminectomy. Methods Between January 2017 and December 2022, seven patients with ROPs who had undergone C1-2 fusion combined with a C1 laminectomy were included in the study. All patients were followed up for >1 year. Bone fusion was evaluated by computed tomography (CT) at one year postoperatively, while implant failure was assessed by radiography at the final follow-up. Clinical evaluations included preoperative and one-year postoperative Japanese Orthopaedic Association (JOA) scores and recovery rates. Results This study included five male and two female patients, with an average age of 71.9 years. The average follow-up duration was 3.3 years. The primary anchor choices included the C1 lateral mass screw and the C2 pedicle screw. In one case, the transarticular screw was utilized unilaterally, and in another case, a lamina screw was utilized unilaterally. One year postoperatively, CT revealed bone fusion in three of the seven patients. Fusion occurred at the lateral and median atlantoaxial joints in two cases and one case, respectively. Screw loosening was observed in one case. None of the patients required reoperations. The average JOA recovery rate was 34.6%. Conclusion This surgical technique is useful for stabilizing and decompressing the C1-2 region while preserving mobility at the OC joint. However, further long-term follow-up studies are required.
齿状突后假瘤（ROPs）的外科治疗方法包括C1椎板切除术以及C1-2和枕颈（OC）融合术。当C1椎板切除术与C1-2融合术联合进行时，由于植骨空间减少，假关节形成风险增加的问题就会出现。可考虑将融合区域扩展至OC区域以确保有足够的植骨床。然而，该手术存在并发症风险。因此，在本研究中，我们调查了C1-2融合术联合C1椎板切除术的骨融合情况及临床结果。
2017年1月至2022年12月期间，7例接受C1-2融合术联合C1椎板切除术的ROPs患者纳入本研究。所有患者均随访超过1年。术后1年通过计算机断层扫描（CT）评估骨融合情况，末次随访时通过X线片评估植入物失败情况。临床评估包括术前和术后1年的日本骨科协会（JOA）评分及恢复率。
本研究包括5例男性和2例女性患者，平均年龄71.9岁。平均随访时间为3.3年。主要的内固定选择包括C1侧块螺钉和C2椎弓根螺钉。1例患者单侧使用了经关节螺钉，另1例患者单侧使用了椎板螺钉。术后1年，CT显示7例患者中有3例实现了骨融合。融合分别发生在2例患者的外侧寰枢关节和1例患者的中间寰枢关节。观察到1例螺钉松动。所有患者均无需再次手术。平均JOA恢复率为34.6%。
该手术技术在稳定和减压C1-2区域的同时可保留OC关节的活动度，是有用的。然而，需要进一步的长期随访研究。
