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Background: The objective of this study is to investigate the outcomes and safety of using percutaneous anterior C1/ 2 transarticular screw fixation as a salvage technique for odontoid fracture if percutaneous odontoid screw fixation fails. Methods: Fifteen in 108 odontoid fracture patients (planned to be treated by percutaneous anterior odontoid screw fixation) were failed to introduce satisfactory odontoid screw trajectory. To salvage this problem, we chose the percutaneous anterior C1/2 transarticular screw fixation technique in treatment of these patients. The visual analogue score (VAS) of neck pain and Neck Disability Index (NDI) of all patients were scored at pre-operation, 3 months after operation, and final follow-up. Additional, technique-related complications were recorded and collected. Results: Percutaneous C1/2 transarticular screw fixation was performed successfully in all 15 patients whose odontoid screw fixation failed. No technique-related complications (such as nerve injury, spinal cord injury, and esophageal injury) occurred. The VAS of neck pain and NDI score improved significantly (P = 0.000) after operation, and no significant differences were found when compared to 93 non-salvage patients who successfully performed the percutaneous anterior odontoid screw fixation. No screw loose or breakage occurred, all of the odontoid fractures achieve radiographic fusion, bony fusion bridge could be observed at the C1/2 lateral articular facet on 9/15 patients. Conclusions: We suggest that percutaneous anterior C1/2 transarticular screw fixation is a good alternative salvage technique if percutaneous odontoid screw fixation failed, and it is a minimally invasive, feasible, and safe technique. [ABSTRACT FROM AUTHOR]

To determine the location of left brachiocephalic vein (BCV) and tracheal bifurcation (TB) relative to the vertebral levels, and to ascertain the accessibility of three different corridors (C1: between the esophagus and trachea medially and the carotid sheath laterally, C2: between the right BCV and the brachiocephalic artery, and C3: between the ascending aorta and superior vena cava) for preoperative planning. From August 2008 to April 2009, normal chest CT scans of 150 subjects ranging in age from 18 to 78 years were selected. According to our definition, of the 150 studies, 132 T2 vertebral bodies (VBs) could be accessed through C1 (88.0%), 100 T3 VBs could be reached through C2 (66.7%), and 110 T4 VBs could be exposed through C3 (73.3%). The results suggest that the surgical accessibility of three different corridors is different and we conclude that T2, T3, and T4 are, respectively, readily accessible through C1, C2, and C3. [ABSTRACT FROM AUTHOR]

Purpose: This research aimed to construct three-dimensional (3D) visible models of the superior mediastinum for anatomic study and surgical approaches to the superior mediastinum. Method: Sectional images of the superior mediastinum were acquired through the Chinese Visible Human Female (VCHF) database. One hundred eighty images of the superior mediastinum were imported into Photoshop CS and the images were converted into a JPEG format. Surface and volume reconstruction were performed by 3D Doctor 3.5 and Amira 4.0 software programs on an ordinary personal computer, respectively. Result: The surface and volume reconstruction of the superior mediastinum were successful. The surface reconstruction model allowed rotation and magnification of the superior mediastinum structures as well as displayed the contours of reconstructed structures individually or as a composite with any other selected structure. Volume reconstruction displayed abundant internal detail of reconstructed images in transverse, coronal, sagittal, and random oblique sections. Conclusion: Three-dimensional, visible models of the superior mediastinum based on the sectional images of VCHF can provide unique insight into the anatomy of superior mediastinum. These models provide an excellent adjunct to the anatomy curriculum in medical schools and an invaluable tool for the practicing surgeon planning an operation in this complex anatomic region. [ABSTRACT FROM AUTHOR]