Percutaneous posterior combined C2 translaminar and pedicle screws using Intraoperative O-arm Navigation in an atypical traumatic spondylolisthesis: Technical notes

Abstract

Introduction: Traumatic spondylolisthesis is the second most common C2 fractures, no Class I or Class II evidence exists regarding the management of traumatic spondylolisthesis of the axis. Case presentation: A 74-year-old German male presented to our emergency room with complaints of severe neck pain and difficulty in neck movements following a domestic accident 3 days ago.CT-cervical spine showed a pedicle fracture in the right side without displacement or angulation and fracture of the lamina in the contralateral side. We considered the fracture as potentially stable. Conservative treatment was recommended. The patient refused the immobilization with the neck collar. The patient underwent a combination of PD und TL percutaneous screw, as navigated instrumented fusion of the craniocervical junction using O-arm Navigation.During surgical approach, the surgeons used realtime images and reference-guiding device to decide the trajectory of the screws, two small skin incisions are placed posteriorly paramedian, the first to stabilize the lamina, the second to pass the right pedicle of C2. Operation time was 45 min and blood loss about 50 ml. The patient was discharge in day 3 and return to normal daily activity. Conclusions: Percutaneous translaminar and pedicle screws stabilization in complex hangman's fractures using Intraoperative O-arm Navigation is a treatment option, provides a rapid return to normal life activity among patients who refuse the external immobilization or present difficult to apply external immobilization. Keywords: Traumatic spondylolisthesis, Translaminar and pedicle screws