Measurement Investigation Of Imaging Parameters In Atlas Vertebroplasty Through Anterolateral Cervical Approach

Background: The upper cervical vertebra refers to the atlas,the axis（including the occipital portion connected to the atlas）and the joints,joint capsules,ligaments and other structures associated with each other.Due to the deep and complex anatomical structure of this area,it was once regarded as a forbidden area for surgery because it was difficult to expose,bleeding and prone to various complications.As an independent minimally invasive surgical method,vertebroplasty and bone augmentation can strengthen the vertebral body of osteolytic lesions,and is a treatment option that patients are very willing to accept in addition to surgical operation.Treatment of osteolytic metastatic carcinoma of the vertebral body with vertebroplasty（VP）or kyphoplasty（KP）is a relatively safe procedure that can successfully relieve pain and improve spinal function due to spinal metastases.However,because of the anatomical relationship between atlas lesions and vertebral artery and spinal cord,vertebroplasty is very difficult,dangerous and challenging to treat.The treatment of vertebral osteolytic lesions caused by malignant tumor metastasis is technically more demanding than the treatment of osteoporotic vertebral compression fractures,especially the surgical treatment of atlas osteolytic metastatic carcinoma under the complex structure of upper cervical spine is more worthy of consideration and exploration by spinal surgeons.Objective: This study aimed at dissolving osseous lesions atlas anatomical structure of the vertebral plasty exploration of the feasibility and technical research,design under the lateral anterior portion into the road via posterior atlanto-axial vertebral puncture of atlas lateral mass operation method,and by measuring the normal crowd cervical vertebra CT three-dimensional reconstruction of auxiliary measuring related anatomic parameters,provide important parameters for clinical specific implementation of the operation.Methods: To summarize the current approaches,procedures and techniques of vertebroplasty for the treatment of metastatic cancer of the atlas by reviewing the literature.On this basis,the relevant imaging data measured by cervical three-dimensional CT were used to guide the safety and operability of injecting bone cement into the lateral mass of atlas via anterolateral cervical puncture needle through the axial vertebral body.The surgical experience of one successful atlas vertebroplasty was summarized and the accuracy of relevant imaging parameters was retrospectively verified.Forty normal people aged 50-60 years who underwent cervical 3D CT aggravation were randomly collected from the imaging system of the First Hospital of Jilin University（20 male and 20 female）,the measurement tools in PACS system were used to reconstruct CT 3D imaging data.On the 3D image,line direction was used to simulate vertebral body forming needle into the needle direction,measured axis center to the edge of the former center of atlas lateral mass around the head Angle outward,axis center to the edge of the former center of atlas lateral head backward tilt Angle,and measuring simulation puncture needle from the axis center to the edge of the former center of atlas lateral mass into the needle distance.Results: The atlantoaxial parameters were measured by CT,and the Angle and distance of the needle were as follows: When the needle was inserted from the midpoint of the anterior and lower edges of the axis,the outward deviation Angle of the head of the needle in the coronal plane was 30.82°±2.41°,and the backward inclination Angle of the head of the needle in the sagittal plane was 15.17°±3.53°.There was no statistical significance between the male and female groups.The insertion distance of the simulated path of vertebroplasty needle was 34.34mm±1.05 mm in male and 29.12mm±1.19 mm in female,and the difference between the two groups was statistically significant.Conclusion: By using the above data,we are working on the lateral anterior portion into the road edge of anatomical separation to atlanto-axial fanterior center,in the data and adjust the Angle of vertebral body shape needle puncture under the guidance of the needle distance,at the same time complementary with C arm machine monitoring,realize the center from the edge of atlanto-axial before puncture needle,the posterior atlanto-axial vertebral bodies have center of atlas lateral mass and bone cement safety injection.With the guarantee of research data,the injury of vertebral artery and spinal cord and other anatomical structures during the puncture of this approach should be minimized to avoid the occurrence of related complications.This study provides detailed theory and reference data for atlas vertebroplasty that the vertebral body puncture needle can safely travel through the axis to the region of atlas lateral mass osteolytic lesions.