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22.11.2018 | Review Article

Potential intraoperative factors of screw-related complications following posterior transarticular C1–C2 fixation: a systematic review and meta-analysis

verfasst von: Ivan Lvov, Andrey Grin, Aleksandr Talypov, Anton Kordonskiy, Vladimir Smirnov, Iliya Grigoriev, Ulugbek Khushnazarov, Vladimir Krylov

Erschienen in: European Spine Journal | Ausgabe 2/2019

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Abstract

Purpose

This study aimed to evaluate the impact of several factors, including patients’ intraoperative position, intraoperative visualization technique, fixation method, and type of screws and their parameters, on the frequency of intraoperative screw-associated complications in posterior transarticular C1–C2 fixation.

Methods

A systematic review of the PubMed database between January 1986 and March 2018 was performed. The key inclusion criteria comprised detailed descriptions of the surgical technique and post-operative screw-associated complications.

Results

The initial search resulted in 1041 abstracts, and a total of 54 abstracts were included in the present study. The overall number of operated patients was 2306. In this group, 4439 screws were inserted. The rate of screw-associated complications during the different time periods was estimated upon meta-analysis. Statistical analysis of the screw malposition rate, vertebral artery injury rate, screw breakage rate based on patients’ intraoperative position, intraoperative visualization technique, fixation method, and type of implants and their parameters was also performed.

Conclusions

The factors that help reduce the rate of screw-associated complications include the intraoperative application of biplanar fluoroscopy or neuronavigation system, the use of 4 mm or thicker lag screws, and screw insertion through contraincisions using cannulated ported instruments. On the other hand, the potential risk factors of screw-associated complications include inadequate intraoperative head fixation using skeletal traction, uniplanar fluoroscopy-guided screw insertion, screw insertion using the posterior midline approach, and the use of 3.5 mm or thinner full-threaded screws.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

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Titel: Potential intraoperative factors of screw-related complications following posterior transarticular C1–C2 fixation: a systematic review and meta-analysis
verfasst von: Ivan Lvov
Andrey Grin
Aleksandr Talypov
Anton Kordonskiy
Vladimir Smirnov
Iliya Grigoriev
Ulugbek Khushnazarov
Vladimir Krylov
Publikationsdatum: 22.11.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: European Spine Journal / Ausgabe 2/2019
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-018-5830-7

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Potential intraoperative factors of screw-related complications following posterior transarticular C1–C2 fixation: a systematic review and meta-analysis

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