Chang Chun-Pi, Kao Ting-Hsien, Lee Hsu-Tung, Shen Chiung-Chyi, Li Chi-Ruei, Tang Chien-Lun
Department of Surgery, Zuoying Armed Forces General Hospital, kaohsiung, Taiwan; Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taiwan.
Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taiwan.
J Clin Neurosci. 2025 Jun 30;139:111424. doi: 10.1016/j.jocn.2025.111424.
C2 pedicle screws (C2 PS) offer superior fixation but pose vertebral artery injury risks, accentuated by a high-riding vertebral artery (HRVA) and narrow C2 pedicle, prompting alternative approaches for safety. This study evaluated the safety and feasibility of an alternative technique.
This retrospective analysis focused on C2 PS placement for atlantoaxial instability and was conducted at Taichung Veterans General Hospital from April 2020 to December 2022. The alternative technique involved a high-speed burr that determined the C2 PS entry point. Tactile palpation-guided screw placement was confirmed using intraoperative fluoroscopy. Preoperative and postoperative computed tomography scans were used to assess pedicle dimensions, screw angles, and breaches. A HRVA and narrow pedicle classification were established. Postoperative scans were used to identify breaches by using a grading system. Radiographic data were assessed independently.
A HRVA was present in 18 out of 39 patients in whom C2 PS placement was performed. Significant differences in the pedicle dimensions and screw angles were observed between the HRVA and non-HRVA groups. The overall breach rate was 15.4 %, with higher rates in the HRVA cases than in the non-HRVA cases (27.8 %). Lateral-inferior breaches were predominant, and all breaches were on the right side. No symptomatic complications were noted.
This alternative technique appears safe and feasible, especially in patients with a HRVA. Shorter pedicle screws may be considered for HRVAs with narrow pedicles. An alternative technique for C2 PS placement appears to be beneficial for reducing breach rates, especially in challenging cases.
C2椎弓根螺钉（C2 PS）提供了卓越的固定效果，但存在椎动脉损伤风险，高位椎动脉（HRVA）和狭窄的C2椎弓根会加剧这种风险，促使人们寻求更安全的替代方法。本研究评估了一种替代技术的安全性和可行性。
这项回顾性分析聚焦于C2 PS用于寰枢椎不稳的情况，于2020年4月至2022年12月在台中荣民总医院进行。替代技术包括使用高速磨钻确定C2 PS的进针点。术中通过透视确认触觉触诊引导下的螺钉置入。术前和术后的计算机断层扫描用于评估椎弓根尺寸、螺钉角度和穿破情况。建立了HRVA和狭窄椎弓根的分类。术后扫描通过分级系统识别穿破情况。影像学数据由独立人员进行评估。
在39例行C2 PS置入的患者中，18例存在HRVA。HRVA组和非HRVA组在椎弓根尺寸和螺钉角度上存在显著差异。总体穿破率为15.4%，HRVA病例的穿破率高于非HRVA病例（27.8%）。外侧下方穿破为主，且所有穿破均发生在右侧。未发现有症状的并发症。
这种替代技术似乎是安全可行的，尤其是对于HRVA患者。对于椎弓根狭窄的HRVA患者，可考虑使用较短的椎弓根螺钉。C2 PS置入的替代技术似乎有利于降低穿破率，尤其是在具有挑战性的病例中。
