Related Experiment Video

Updated: Jan 23, 2026

Intraoperative Ultrasound in Spinal Surgery

Intraoperative Ultrasound in Spinal Surgery

Published on: August 17, 2022

Safety and Efficacy of Posterior Atlanto-Axial Stabilization Using Intraoperative Navigation System with Preoperative

Vito Fiorenza¹, Francesco Ascanio¹

¹Neurosurgery Department, ARNAS Civico Di Cristina Benfratelli Hospital, Palermo, Italy.

World Neurosurgery

|June 7, 2019

Abstract

Background:

Surgical approaches for posterior C1-C2 arthrodesis, such as C1-C2 transarticular and C1-C2 screw stabilization, are known to be demanding because of the anatomic close proximity of cervical vertebrae to neurovascular structures. Currently, navigation by fluoroscopy or intraoperative computed tomography (ICT) is the standard practice. However, fluoroscopy has various limitations, and ICT is time consuming and not available in many centers; furthermore, both diagnostic tools lead to exposure of the operating room staff to radiation exposure. We evaluate the safety, efficacy, and facility of a navigation system using only preoperative cervical computed tomography and computed tomographic angiography (CT/CTA), to prevent the risk of neurovascular damage in atlantoaxial stabilization.

Methods:

The authors report a series of 21 patients who underwent posterior upper cervical spine fixation using a navigation system with intraoperative single-level vertebral registration on preoperative cervical CT/CTA (software BrainLab IPlan Spine 3.0). Intraoperative and postoperative comparative analysis was performed to verify the correspondence between the virtual anatomic position of the surgical instruments and screws represented on the neuronavigator, and the actual positions verified intraoperatively and on postoperative CT.

Results:

Thirteen patients underwent C1-C2 arthrodesis with a Harms construct, 1 patient with transarticular screw fixation and 4 patients with occipitocervical stabilization. Three patients underwent C1-C2-C3 stabilization with C1 hooks, C2-C3 screws, and rod construct. On postoperative CT, the position of all screws appeared satisfactory. No neurovascular damage occurred in any patients.

Conclusions:

The use of a neuronavigation system, based on preoperative acquired cervical CT and intraoperative single-vertebra registration, may provide a valuable support for the improvement of the surgical accuracy of posterior C1-C2 screw fixation.

Keywords:

3D intraoperative imaging Atlanto-axial joint Atlanto-occipital joint Axis Cervical Cervical atlas Neuro-navigation Spine

More Related Videos

Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion

Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion

Published on: August 6, 2019

3D Printing of Preclinical X-ray Computed Tomographic Data Sets

3D Printing of Preclinical X-ray Computed Tomographic Data Sets

Published on: March 22, 2013

Related Concept Videos

Axial and Appendicular Muscles

Axial and Appendicular Muscles

Skeletal muscles, the key players in our body's movement, can be classified into two groups based on their location and function: axial muscles and appendicular muscles. These classifications reflect the primary roles the muscles play in the body's structure and movement.
Axial Muscles
Axial muscles, situated along the body's midline, are intricately connected to the axial skeleton, which includes the skull, spine, ribs, and sternum. These muscles facilitate facial expressions and...

Survey Safety

Survey Safety

Surveying near highways, rough terrain, or power lines involves significant risks. Working along highways is particularly dangerous and requires the use of warning signs and flagmen. It is safest to avoid working directly on roads and use offsets whenever possible. When highway work is unavoidable, it must follow all safety guidelines. Surveyors should wear bright clothing, such as orange reflective vests, to ensure visibility to motorists, coworkers, and hunters. In construction zones, wearing...

General Case of Eccentric Axial Loading

General Case of Eccentric Axial Loading

Unsymmetrical bending occurs when the bending moment applied to a structural member does not align with its principal axis. This misalignment leads to complex stress distributions and deflection patterns that differ from symmetrical bending, which are essential for designing structures to withstand different loading conditions.
Consider a member subjected to equal and opposite forces that are applied along a line that does not coincide with the member's neutral axis. In unsymmetrical...

Overview of the Axial Skeleton

Overview of the Axial Skeleton

The skeleton is subdivided into two major divisions—the axial skeleton and the appendicular skeleton. The axial skeleton forms the vertical, central axis of the body. It includes all of the bones of the head, neck, chest, and back. It protects the brain, spinal cord, heart, and lungs. It also serves as the attachment site for muscles that move the head, neck, and back and for muscles that act across the shoulder and hip joints to move their corresponding limbs.
The axial skeleton of the...

Nuclear Stability

Nuclear Stability

Protons and neutrons, collectively called nucleons, are packed together tightly in a nucleus. With a radius of about 10−15 meters, a nucleus is quite small compared to the radius of the entire atom, which is about 10−10 meters. Nuclei are extremely dense compared to bulk matter, averaging 1.8 × 1014 grams per cubic centimeter. If the earth’s density were equal to the average nuclear density, the earth’s radius would be only about 200 meters.
To hold positively charged protons together...

RNA Stability

RNA Stability

Intact DNA strands can be found in fossils, while scientists sometimes struggle to keep RNA intact under laboratory conditions. The structural variations between RNA and DNA underlie the differences in their stability and longevity. Because DNA is double-stranded, it is inherently more stable. The single-stranded structure of RNA is less stable but also more flexible and can form weak internal bonds. Additionally, most RNAs in the cell are relatively short, while DNA can be up to 250 million...

Articles linked to this work by shared authors, journal, and citation graph.

Nuance in Craniovertebral Junction Surgical Approach for Posterior C1-C2 Harms Stabilization: "Window Transposition" of the External Vertebral Venous Plexus for Bloodless C1 Lateral Mass Screw Insertion: Anatomical Aspects and Technical Notes.

Acta neurochirurgica. Supplement·2023

Glomus Cervical Arteriovenous Malformation Presenting with Intracranial Subarachnoid Hemorrhage: Clinical Case and Pial Resection Surgical Technique Description.

World neurosurgery·2023

Multidrug-resistant Gram-negative post-neurosurgical meningitis and the role of intraventricular colistin: a case series.

Le infezioni in medicina·2021

Clinicopathologic Features of Thoracolumbar Interdural Disc Herniations: A Retrospective Case Series with a Systematic Literature Review.

World neurosurgery·2020

Percutaneous Endoscopic Transforaminal Outside-In Outside Technique for Foraminal and Extraforaminal Lumbar Disc Herniations-Operative Technique.

World neurosurgery·2019

Reconstruction of vertebral body in thoracolumbar AO type A post-traumatic fractures by balloon kyphoplasty: a series of 85 patients with a long follow-up and review of the literature.

Journal of neurosurgical sciences·2019

See all related articles