C1-C2 fiksacija šrafom kod bolesnika sa anomalijom toka vertebralne arterije
Sažetak
Uvod. Atlantoaksijalni kompleks je veoma kompleksna anatomska struktura, a otvorena redukcija C1-C2 luksacije veoma je zahtevna procedura. Nestabilnost atlantoaksijalnog kompleksa može nastati kao posledica traumatskih, inflamatornih, neoplastičnih, kongenitalnih ili degenerativnih oboljenja. Poznavanje anatomije vertebralne arterije ključno je za obavljanje hirurgije u ovoj regiji, a transpedikularno plasiranje C2 šrafa ponekad nije moguće. U ovim situacijama, translaminarno plasiranje šrafova u C2 pršljen obezbeđuje alternativan način fiksacije, bez opasnosti od povrede vertebralne arterije. Prikaz bolesnika. Prikazan je bolesnik, star 54 godine, sa cervikalnom mijelopatijom kao posledicom traumatske atlantoaksijalne subluksacije. Kompjuterizovana tomografska angiografija pokazala je obostranu anomaliju vertebralne arterije “high-riding” tipa. Bolesnik je operisan, učinjena je C1-C2 zadnja stabilizacija šrafovima. Zbog anomalne pozicije vertebralne arterije šrafovi su plasirani u lamine C2 pršljena. Postignuta je odlična repozicija subluksacije kao i odličan neurološki oporavak bolesnika. Zaključak. Hirurški tretman C1-C2 luksacije predstavlja veliki izazov. Opisane su brojne hirurške tehnike u tretmanu atlantoaksijalne fiksacije. C2 translaminarno plasiranje šrafova je alternativna metoda stabilizacije u tretmanu atlantoaksijalne nestabilnosti, posebno u slučajevima anomalije vertebralne arterije.
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