Werthein occipital neck fusion

Werthein occipitocervical fusion is used for the surgical treatment of odontoid deformities. A odontoid deformity is a rare congenital malformation, including odontogenic dysplasia, odontoid distal bone, odontoid separation, and odontoid absence. The odontoid deformity is fixed only to the atlantoaxial joint by local ligamentous tissue, which makes the local instability, and it is easy to cause spinal cord injury due to dislocation caused by trauma. Clinically, it can be asymptomatic, but when it is slightly traumatized, symptoms of medullary or upper cervical spinal cord compression may occur. Reports in the literature are mostly affected by adolescents, manifested by decreased muscle strength, ataxia, pain in the lower part of the pillow and neck, torticollis, muscle tension, and limited mobility. Some may be progressive numbness of the limbs, and severe cases of quadriplegia and death. Most of the treatments advocate active surgery. For unintentional examinations, it is controversial whether or not to prevent the instability of the odontoid before and after the astigmatism is less than 5 mm, because the neck activity of the sick child is difficult to be accepted by the sick child and parents. The pros and cons of surgical and non-surgical treatment should be clearly explained before making a decision on whether or not to perform preventive fusion. For those with pain in the neck, the neck support can be fixed first. If no improvement is made, the atlantoaxial fusion is performed. For patients with unstable cervical spine and radiculopathy, occipitocervical fusion is feasible. For the cervical spinal cord compression, the posterior or posterior atlantoaxial laminectomy is performed, the occipital foramen is enlarged, and the fibrous band is removed to relieve the oppression of the cerebellum, the medulla and the upper cervical spinal cord, and then the occipitocervical fusion is performed. When the odontoid deformity is combined with the absence of the C1 posterior arch, atlantoaxial fusion cannot be performed, and the fusion range should extend to the occipital bone. There are many methods of occipital fusion. Robinson and Southwick's method is to pass each wire under the C1 and C2 lamina, which is more dangerous. In recent years, Wertheim and other scholars have used a modified posterior occipitocervical fusion to form a bone hole on the outer surface of the occipital protuberance through a dental drill. The steel wire only passes through the external skull plate. Because the skull is thicker, it is allowed to wear only the steel wire. Through the outer skull plate, the risk of injury to the superior sagittal sinus is significantly reduced. Koop et al. introduced a occipital and neck arthrodesis in children who did not require internal fixation. After the cortical bone was removed from the cortex, the autologous cortical-cancellous humerus was placed at the site to be fused. For children with vertebral arch defects, the occipital periosteum is folded back to the bone defect to provide a layer of osteogenic tissue for the graft. Postoperatively fixed with HALO plaster. In recent years, there has also been a occipitocervical fusion with a "U" shaped rod and a segmental wire. This procedure has the advantage of early stability of the occipital and neck joints. This method allows the patient to have neck support after surgery and avoids HALO braking. Treatment of diseases: odontoid malformation Indication Werthein occipitocervical fusion is suitable for: 1. The odontoid deformity causes neurological symptoms. 2. The dentate process is unstable and shifts forward or backward by more than 5 mm. 3. The dentate process is unstable and persistently aggravated. 4. The neck is persistently discomfort due to instability of the atlantoaxial axis and is not relieved by conservative treatment. 5. The posterior arch of the atlas is incomplete and is not suitable for atlantoaxial fusion. Contraindications Patients with no clinical symptoms should be closely observed to avoid trauma, and can be fixed with a neck collar. Preoperative preparation 1. X-ray of lateral position and open position of the neck, showing odontoid deformity, CT examination showed odontoid deformity type. 2. MRI examination to understand the compression of the cervical spinal cord and nerve roots, further excluding syringomyelia, cervical spinal cord or cerebellar tumor. 3. Patients with neurological symptoms should first perform skull traction for 1 to 2 weeks, make it reset, restore nerve function, reduce cervical spinal irritation, and then consider surgery. 4. Bed bed training and prone position training. 5. Prefabricated one of the back and ventral plaster beds, the length from the top of the head to the middle of the double thighs. 6. 1st preoperative 1d neck 2 spinous process positioning, help to determine the location of the spinous process during surgery, and determine the appropriate line of force from the cervical lateral radiograph. Surgical procedure Incision The occipital bulge is incision to the longitudinal line of the C5 spinous process. 2. Exposing the extra-occipital protuberance and cervical lamina The skin, subcutaneous tissue and ligament were cut along the direction of the incision. The muscles and soft tissues attached to the spinous processes were removed under the periosteum, and the spinous processes positioned before the operation were first revealed as a marker to reveal from the C3 lamina to the extraoccipital protuberance. The muscles around the spinous process are sharply separated, and the occipital and cervical laminae are further exposed under the periosteum with a scalpel and periosteal stripper. Be careful not to expose too much to both sides to avoid damage to the midline venous plexus. After the automatic retractor is retracted, the wound is pressed against the gauze to stop bleeding. 3. Bone graft The autogenous iliac crest is approximately equal to the length of the occipital protuberance to the C3 spinous process, the width of which is approximately equal to the width of the cervical lamina, and the lower tibial incision is closed after removing a portion of the thin strip. Cut the cut humerus into two halves and drill 3 holes in each half of the bone. Then, through the dental drill, 2 small holes are drilled in the outer plate of the extra-occipital protuberance 2 cm above the large foramen magnum, and the depth is up to the external plate of the skull, and the two holes are communicated to facilitate the passage of the steel wire. A hole is then formed in the spinous process of the second cervical spine. Wear a 20-gauge wire on the occipital protuberance, the atlas of the atlas, and the spinous process of the second cervical vertebrae, respectively, through the ring, with the convex surface of the bone facing down, the concave side facing up, and the bone through the wire. The upper hole of the block is fixed on the occipital bone, and the lower two bone holes are respectively fixed with the atlas and the second cervical spine. Fill the bones on both sides of the bone. 4. Close the incision After completely stopping bleeding, the wound was washed with saline, and the ligament was sutured with a thick thread. If there is more bleeding, a vacuum suction should be placed in the wound, and the subcutaneous tissue and skin should be sutured layer by layer. complication High paraplegia Intraoperative operation accidentally injured the cervical cord. 2. Post-transplantation healing Incomplete soft tissue removal on the lamina surface or insufficient amount of implanted bone tissue will affect healing.