Colocação de parafusos atlantoaxiais posteriores em uma população portuguesa: Uma análise morfométrica baseada em medidas de tomografia computadorizada

Resumo

Objetivo O presente estudo tem como objetivo avaliar o comprimento e os ângulos de trajetória do parafuso para fixação atlantoaxial posterior em uma população portuguesa por meio do estudo de tomografia computadorizada (TC) cervical.

Métodos Tomografias computadorizadas cervicais de 50 adultos foram analisadas quanto às trajetórias pré-definidas dos parafusos transarticulares C1-C2 (C1C2TA), na massa lateral de C1 (C1LM), no pedículo de C2 (C2P) e na pars de C2 e C2 laminar (C2L). O comprimento e os ângulos dos parafusos em cada uma destas trajetórias foram medidos e comparados entre homens e mulheres.

Resultados O comprimento médio e ângulos medial e cranial da trajetória do parafuso C1C2TA foram de 34,12 ± 3,19 mm, 6,24° ± 3,06 e 59,25° ± 5,68, respectivamente; as medidas da trajetória do parafuso C1LM foram 27,12 ± 2,15 mm, 15,82° ± 5,07 e 13,53° ± 4,80. O comprimento médio e os ângulos medial e cranial da trajetória do parafuso C2P foram de 23,44 ± 2,49 mm, 27,40° ± 4,88 e 30,41° ± 7,27, respectivamente; as medidas da trajetória do parafuso da pars de C2 foram 16,84 ± 2,08 mm, 20,09° ± 6,83 e 47,53° ± 6,97. O comprimento médio e ângulos lateral e cranial da trajetória do parafuso C2L foram de 29,10 ± 2,48 mm, 49,80° ± 4,71 e 21,56° ± 7,76, respectivamente. Não houve diferenças entre os gêneros, à exceção do comprimento dos parafusos C1C2TA (p = 0,020) e C2L (p = 0,001), que foi maior no sexo masculino do que no feminino.

Conclusão O presente estudo fornece referências anatômicas para a fixação atlantoaxial posterior em uma população portuguesa. Estes dados detalhados são essenciais para ajudar os cirurgiões de coluna a colocar os parafusos de maneira segura e eficaz.

Palavras-chave

articulação atlantoaxial - parafusos ósseos - vértebra cervical - instabilidade articular - dispositivos de fixação cirúrgica

Suporte Financeiro

Os autores não têm informações financeiras a declarar.

Estudo desenvolvido no Departamento de Ortopedia, Centro Hospitalar Universitário do Porto, Porto, Portugal.

Publication History

Received: 02 January 2022

Accepted: 20 January 2022

Article published online:
11 July 2022

• Referências

• 1 Lopez AJ, Scheer JK, Leibl KE, Smith ZA, Dlouhy BJ, Dahdaleh NS. Anatomy and biomechanics of the craniovertebral junction. Neurosurg Focus 2015; 38 (04) E2
• 2 Yang SY, Boniello AJ, Poorman CE, Chang AL, Wang S, Passias PG. A review of the diagnosis and treatment of atlantoaxial dislocations. Global Spine J 2014; 4 (03) 197-210
• 3 Gautschi OP, Payer M, Corniola MV, Smoll NR, Schaller K, Tessitore E. Clinically relevant complications related to posterior atlanto-axial fixation in atlanto-axial instability and their management. Clin Neurol Neurosurg 2014; 123: 131-135
• 4 Lyons C, Ross M, Elliott R, Tall M. Atlantoaxial instability in a patient with neck pain and ankylosing spondylitis. Mil Med 2018; 183 (9-10): e654-e657
• 5 Chen Q, Brahimaj BC, Khanna R. et al. Posterior atlantoaxial fusion: a comprehensive review of surgical techniques and relevant vascular anomalies. J Spine Surg 2020; 6 (01) 164-180
• 6 Jeanneret B, Magerl F. Primary posterior fusion C1/2 in odontoid fractures: indications, technique, and results of transarticular screw fixation. J Spinal Disord 1992; 5 (04) 464-475
• 7 Harms J, Melcher RP. Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976) 2001; 26 (22) 2467-2471
• 8 Huang D-G, Hao D-J, He B-R. et al. Posterior atlantoaxial fixation: a review of all techniques. Spine J 2015; 15 (10) 2271-2281
• 9 Wright NM. Posterior C2 fixation using bilateral, crossing C2 laminar screws: case series and technical note. J Spinal Disord Tech 2004; 17 (02) 158-162
• 10 Liu S, Song Z, Liu L. et al. Biomechanical evaluation of C1 lateral mass and C2 translaminar bicortical screws in atlantoaxial fixation: an in vitro human cadaveric study. Spine J 2018; 18 (04) 674-681
• 11 Sugawara T, Higashiyama N, Kaneyama S, Sumi M. Accurate and Simple Screw Insertion Procedure With Patient-Specific Screw Guide Templates for Posterior C1-C2 Fixation. Spine (Phila Pa 1976) 2017; 42 (06) E340-E346
• 12 Du JY, Aichmair A, Kueper J, Wright T, Lebl DR. Biomechanical analysis of screw constructs for atlantoaxial fixation in cadavers: a systematic review and meta-analysis. J Neurosurg Spine 2015; 22 (02) 151-161
• 13 Rajinda P, Towiwat S, Chirappapha P. Comparison of outcomes after atlantoaxial fusion with C1 lateral mass-C2 pedicle screws and C1-C2 transarticular screws. Eur Spine J 2017; 26 (04) 1064-1072
• 14 Nogueira-Barbosa MH, Defino HL. Multiplanar reconstructions of helical computed tomography in planning of atlanto-axial transarticular fixation. Eur Spine J 2005; 14 (05) 493-500
• 15 Lu X, Xu T. Advantages and Disadvantages of Traditional Atlantoaxial Fusion Techniques. In: Ni B, Guo X, Guo Q. eds. Atlantoaxial Fixation Techniques. Translational Medicine Research. Singapore: Springer; 2018: 39-48
• 16 Sim HB, Lee JW, Park JT, Mindea SA, Lim J, Park J. Biomechanical evaluations of various c1-c2 posterior fixation techniques. Spine (Phila Pa 1976) 2011; 36 (06) E401-E407
• 17 Blagg SE, Don AS, Robertson PA. Anatomic determination of optimal entry point and direction for C1 lateral mass screw placement. J Spinal Disord Tech 2009; 22 (04) 233-239
• 18 Simsek S, Yigitkanli K, Seçkin H. et al. Ideal screw entry point and projection angles for posterior lateral mass fixation of the atlas: an anatomical study. Eur Spine J 2009; 18 (09) 1321-1325
• 19 Christensen DM, Eastlack RK, Lynch JJ, Yaszemski MJ, Currier BL. C1 anatomy and dimensions relative to lateral mass screw placement. Spine (Phila Pa 1976) 2007; 32 (08) 844-848
• 20 Rocha R, Safavi-Abbasi S, Reis C. et al. Working area, safety zones, and angles of approach for posterior C-1 lateral mass screw placement: a quantitative anatomical and morphometric evaluation. J Neurosurg Spine 2007; 6 (03) 247-254
• 21 Hu Y, Dong WX, Spiker WR. et al. An anatomic study to determine the optimal entry point, medial angles, and effective length for safe fixation using posterior C1 lateral mass screws. Spine (Phila Pa 1976) 2015; 40 (04) E191-E198
• 22 Meyer D, Meyer F, Kretschmer T, Börm W. Translaminar screws of the axis–an alternative technique for rigid screw fixation in upper cervical spine instability. Neurosurg Rev 2012; 35 (02) 255-261
• 23 Chun DH, Yoon DH, Kim KN, Yi S, Shin DA, Ha Y. Biomechanical Comparison of Four Different Atlantoaxial Posterior Fixation Constructs in Adults: A Finite Element Study. Spine (Phila Pa 1976) 2018; 43 (15) E891-E897
• 24 Sai Kiran NA, Sivaraju L, Vidyasagar K. et al. Safety and Accuracy of Anatomic and Lateral Fluoroscopic-Guided Placement of C2 Pars/Pedicle Screws and C1 Lateral Mass Screws, and Freehand Placement of C2 Laminar Screws. World Neurosurg 2018; 118: e304-e315
• 25 Lehman Jr RA, Dmitriev AE, Helgeson MD, Sasso RC, Kuklo TR, Riew KD. Salvage of C2 pedicle and pars screws using the intralaminar technique: a biomechanical analysis. Spine (Phila Pa 1976) 2008; 33 (09) 960-965
• 26 Dobran M, Nasi D, Esposito DP, Iacoangeli M. Posterior Fixation with C1 Lateral Mass Screws and C2 Pars Screws for Type II Odontoid Fracture in the Elderly: Long-Term Follow-Up. World Neurosurg 2016; 96: 152-158
• 27 Chin KR, Mills MV, Seale J, Cumming V. Ideal starting point and trajectory for C2 pedicle screw placement: a 3D computed tomography analysis using perioperative measurements. Spine J 2014; 14 (04) 615-618
• 28 Dean CL, Lee MJ, Robbin M, Cassinelli EH. Correlation between computed tomography measurements and direct anatomic measurements of the axis for consideration of C2 laminar screw placement. Spine J 2009; 9 (03) 258-262