Pedicle screw more efficacious vs lateral mass screw fixation in atlantoaxial instability .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2016;4(15):26 BMC Musculoskelet Disord. 2016 Apr 14;17(1):164140 patients with atlantoaxial instability (AAI), with C1 posterior arches greater than 4mm, were randomized to undergo either C1 pedicle or lateral mass screw fixation. The purpose of this study was to compare the feasibility and clinical outcomes of the two treatments of AAI after a mean follow-up period of 24.5 months. Findings indicated that C1 pedicle screw fixation may be less invasive and yield fewer complications compared to C1 lateral mass screw fixation.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
3/4
Aleatorización
4/4
Medición de resultados
4/4
Inclusión / exclusión
4/4
Descripción de la terapia
3/4
Estadísticas
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
Atlantoaxial instability (AAI) is atypical movement at the cervical region, in between the atlas and axis, caused by malformation of bone or alterations of ligament. Atlantoaxial fixation is required to repair the instability, though various approaches that have been previously used, such as sublaminar wiring, Harms and Magerl techniques, have reported many postoperative complications followed by substantial rates of non-union. The Harms method utilizes polyaxial screws that are independently inserted into the C1 posterior arch and C2 pedicles, thereby allowing C1 posterior arch fixation to be split into pedicle and lateral mass screw fixation. The present study aims to compare the clinical outcomes of C1 pedicle and lateral mass screw fixation methods in treatment of AAI.
Qual era a principal questão de investigação?
In treatment of atlantoaxial instability, how do C1 pedicle and lateral mass screw fixation compare with regards to feasibility and clinical outcomes, as assessed up to 38 months postoperatively?
- A significantly shorter mean operation time was reported in the Pedicle screw group compared to the Lateral mass group (85 +/- 11 vs. 110 +/- 17 minutes, respectively; p<0.01).
- Significantly less volume of blood was lost in the Pedicle screw group compared to the Lateral mass group (180 +/- 40 vs. 370 +/- 80 ml, respectively; p<0.01)
- Hospitalization time, JOA scores, and VAS scores were similar between groups (p>0.05).
- JOA and VAS scores were significantly improved within both groups from preoperation to final follow-up (both p<0.01).
- No postoperative hardware complications were observed in any patient up to final follow-up; however, 6 cases of inferior wall fracture of the posterior arch, 2 cases of penetration of axis pedicle screws into the vertebroarterial foramen, and 2 cases of medial wall fracture of the axis pedicle were reported.
- 13 cases of burst bleeding from the C1-2 venous plexus during surgery and 9 cases of immediate pain and numbness in the occipitocervical region caused by C2 nerve roots irritation were noted in the Lateral mass group compared to no incidences in the Pedicle screw group (both p<0.01).
De que é que me devo lembrar mais?
In treatment of atlantoaxial instability, an operative procedure using C1 pedicle screw fixation was reported to result in a significantly shorter operation time, lower volume of blood loss, and fewer venous plexus and nerve root injuries compared to the C1 lateral mass screw fixation method. However, hospitalization time, Japanese Orthopaedic Association scores, and visual analogue scale scores were comparable between groups.
Como é que isto afectará o tratamento dos meus doentes?
The results of this study suggest that the C1 pedicle screw fixation method may be less invasive and less complicated compared to C1 lateral mass screw fixation for patients with atlantoaxial instability. Further trials with longer follow-up periods are required to evaluate the long-term effects between groups.
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