環軸椎後方固定術における合併症回避の工夫

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  • Complication Avoidance and Management in Posteriorly Instrumented C1-2 Fusion

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<p>  Objective : Once atlantoaxial joint instability has been detected, the goal of surgery is to reduce pathological subluxation, decompress neural elements and maintain vertebral column alignment. Herain, the surgical technique for internal fixation and fusion at the atlantoaxial joint is presented with an emphasis on complication avoidance.</p><p>  Patients and methods : The patient record included a total of 12 patients with the atlantoaxial instability (11 male and 1 female), who underwent surgery over the past four years. The age of the patients ranged from 16 to 75 years old. Patients were classified into 7 in trauma group, and 5 in rheumatoid arthritis or degeneration group based on their etiology. Goel-Harms method with a cancellous screw and rod system was preferably used. In the cases of retroodontoid pseudotumor with chronic atlantoaxial instability, the posterior C1 arch was resected and combined with posterior fusion.</p><p>  Results and conclusion : None of the patients demonstrated neurological deterioration after surgery. All of the patients with retroodontoid pseudotumor demonstrated neurological recovery with gradually diminishing pseudotumor. In one case treated by Megerl method, revision surgery was accomplished to achieve complete bone fusion. To avoid the surgical complications, selection and safe placement of C2 anchor screws, sufficient exposure of the lateral atlantoaxial joint, and fusion technique are key elements for successful surgery.</p>

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  • 脊髄外科

    脊髄外科 23 (1), 121-127, 2009

    日本脊髄外科学会

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