Abstract
BackgroundOur research was designed to decide whether the application of C2 pars screws is an alternative choice for patients with OPLL involving the C2 segment.MethodsA total of 40 patients who underwent cervical laminectomy with fusion (LF) from C2 to C6 for OPLL were reviewed. Among them, C2 pedicle screws were placed in 23 patients, who were the pedicle group, and C2 pars screws were placed in 17 patients, who were the pars group. The screw placement and vertebral artery (VA) anatomy presented by standard CT. General clinical characteristics and health-related outcomes were evaluated and compared preoperatively and during the follow-up period.ResultsThe Pars group tended to have a shorter operation duration and less blood loss than the pedicle group (operation time: 115.29 ± 28.75 vs 133.48 ± 26.22, p = 0.044; blood loss: 383.53 ± 116.19 vs 457.83 ± 145.45, p = 0.039). Operation time and blood loss were both independently related to the pars group (operation time: OR = 0.966, p = 0.021; blood loss: OR = 0.993, p = 0.046). The idealization and acceptability of C2 screws in the pars group exceeded those in the pedicle group (100% vs 91.3%). However, no statistically obvious variation in the included complications or health-related outcomes between the pedicle and pars groups was observed.ConclusionIn the treatment of patients with OPLL involving the C2 segment, the application of C2 pars screws is an alternative choice, which is not only safer but also reduces the amount of blood loss, shortens the operation time and obtains a more ideal screw placement.
Highlights
As a multifactorial disease caused by ectopic bone hyperplasia and posterior longitudinal ligament calcification [1], Ossification of the posterior longitudinal ligament (OPLL) is the most common among males, the elderly and Asian patients [2] and can lead to spinal cord injury after minor trauma
This technique of C2 screw placement is obviously a viable option for posterior C2 instruments, and it may reduce the risk of vertebral artery (VA) injury, especially among patients with challenging VA anatomy
The decision on which screw placement method to use to fix C2 is based on the surgeon’s preference and the screw placement and VA anatomy presented by standard preoperative computed tomography (CT)
Summary
As a multifactorial disease caused by ectopic bone hyperplasia and posterior longitudinal ligament calcification [1], Ossification of the posterior longitudinal ligament (OPLL) is the most common among males, the elderly and Asian patients [2] and can lead to spinal cord injury after minor trauma. The development of the C2 posterior instrumental method enables surgeons to more closely select the stabilization approach of their choice based on the anatomy of a specific patient [4, 5], and increasingly diverse screw placement methods have added increasing versatility to the treatment of cervical diseases Both C2 pedicle screws and C2 pars screws (sometimes called isthmic screws), as good fixation approaches in posterior upper cervical spine surgery [6, 7], are receiving increasing attention. Compared with C2 pedicle screws, it remains controversial as to whether pars screws provide enough rigid fixation from the perspective of biomechanics [11] and whether they are accompanied by a higher incidence of false joints from the perspective of clinical efficacy [12,13,14] These descriptions of screw placement are all for upper cervical surgery. Our research was designed to decide whether the application of C2 pars screws is an alternative choice for patients with OPLL involving the C2 segment
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