Percutaneous posterior combined C2 translaminar and pedicle screws using Intraoperative O-arm Navigation in an atypical traumatic spondylolisthesis: Technical notes

Publication date: Available online 3 March 2017
Source:Interdisciplinary Neurosurgery
Author(s): Peter Douglas Klassen, Bert Baume, Alaa Eldin Elsharkawy
IntroductionTraumatic spondylolisthesis is the second most common C2 fractures, no Class I or Class II evidence exists regarding the management of traumatic spondylolisthesis of the axis.Case presentationA 74-year-old German male presented to our emergency room with complaints of severe neck pain and difficulty in neck movements following a domestic accident 3days ago.CT-cervical spine showed a pedicle fracture in the right side without displacement or angulation and fracture of the lamina in the contralateral side. We considered the fracture as potentially and conservative treatment has been recommended. The patient refused the immobilization with the neck collar. The patient underwent a combination of PD und TL percutaneous screw, as navigated instrumented fusion of the craniocervical junction using O-arm Navigation.In surgical approach, the surgeons used the realtime images and reference-guiding device to decide the trajectory of the screws, two small skin incisions are placed posteriorly paramedian, the first to stabilize the lamina, the second to pass the right pedicle of C2. Operation time was 45min and blood loss about 50ml. The patient has been discharge in day 3 and return to normal daily activity.ConclusionsPercutaneous translaminar and pedicle screws stabilization in complex hangman's fractures using Intraoperative O-arm Navigation is a treatment option, provides a rapid return to normal life activity among patients who refuse the external immobilization or difficult to apply external immobilization.



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