Abstract
Introduction
Hospital Santo Tomas is a tretary trauma center in Panama. Subaxial cervical trauma represents a major issue in the care of patients admitted to the neurosurgery department. Lateral mass screw placement is commonly used for posterior fixation. The aim of this abstract is to present our experience not only with transpedicular screws but also doing this with a neuronavigation system and to evaluate the associated risks.
Materials and Methods
19 patients in need of posterior fixation with subaxial cervical trauma were stabilized by transpedicular screws from 2010 to 2012 were included. The patients were all male between 20 and 34 years of age. After hemodynamics parameter were assessed and other major trauma was ruled out the neurologic assessment was made. We used the Frankel grading scale and 10 patients were graded A, 4 graded C, 3 graded D an 2 graded E. By this moment a whole body CT was already done. 12 patients have C4-C5 subluxation and the remain had subluxation elsewhere in the subaxial cervical spine. 13 patients needed closed reduction which was assessed by plain films. All patiens had thin cut CT and navigation was planned. All patients were induced by a nueroanesthesiolgy. A three pin head holder was applied and the patients were put in a down face position. Calibration of the navigation system was performed and a standard posterior cervical spine with laminectomy was done. Our hospital does not count until that moment with the aid of intraoperative neurophysiological monitoring. The average surgical time was 3 hours and the blood loss was 750 cc in average. In total 52 screws were placed. All the patients went to a immediately postoperative CT scan. And the screws placement was assessed. No screw mal placement was and no complications during the placement were recorded. The patients were managed in the neurosurgical ward and were discharge 48 hours after the operation with a cervical collar. They were assessed one week after the intervention to review the surgical wound and to preformed a neurological exam. All patients were follow in the outpatient clinic and all were given physical therapy that initiated in the immediately postoperative period.
Results
Of the Frankel a group three of went on to have grade C, two were graded B and the remain did not improve. One patient in the Frankel C and one in the Frankel D group did better during follow up. No surgical wound infections were recorded. Only one of the patients died from and unrelated cause of pneumonia. All patients were assessed with dynamic films and show no movement. The follow up was up to a year. No patients were lost during that time in the follow up.
Conclusion
Tanspedicular screw placement is a safe option for posterior fixation. Neuronavigation is and excellent tool for avoiding complications.