- Department of Neurosurgical, Klinikum Dortmund, Dortmund, Germany
Department of Neurosurgical, Klinikum Dortmund, Dortmund, Germany
DOI:10.4103/sni.sni_10_18Copyright: © 2018 Surgical Neurology International This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
How to cite this article: Ali Harati, Rolf Schultheiß. New technique for C1-C2 fixation. 07-May-2018;9:94
How to cite this URL: Ali Harati, Rolf Schultheiß. New technique for C1-C2 fixation. 07-May-2018;9:94. Available from: http://surgicalneurologyint.com/surgicalint-articles/new-technique-for-c1%e2%80%91c2-fixation/
Background:There are several techniques for treating atlantoaxial instability, including the Magerl transarticular screw fixation and the Harms/Goel C1-C2 screw rod techniques. Here, we present a novel technique utilizing a polyaxial screw rod system and a combination of C1 lateral mass and C1-C2 transarticular screws.
Methods:We retrospectively reviewed 14 patients (7 women, 7 men; mean age 62) who underwent surgery for type II odontoid fractures (n = 7), pseudarthrosis after anterior odontoid screw placement (n = 3), Os odontoideum (n = 2), atlantoaxial instability after C3-C5 fusion (n = 1), and craniovertebral rheumatoid arthritis (n = 1). Ten patients underwent posterior C1-C2 fixation, three patients with osteoporosis had C1-C4 fixation, and one patient had C1-Th1 fixation. The mean follow-up time was 22 months.
Results:Intraoperatively, there were no complications (e.g., vertebral artery, nerve root, or spinal cord injury). Postoperative imaging showed no screw malpositioning, and no screw loosening, fracture, or bone absorption around the screws. Furthermore, all patients exhibited postoperative improvement in neck pain.
Conclusions:C1 lateral mass and C1-C2 transarticular polyaxial screw rod fixation techniques were effective in achieving immediate rigid immobilization of the C1-C2 motion segment.
Keywords: Atlantoaxial instability, C1-C2 Fixation, craniocervical junction, odontoid fracture, os odontoideum
Several techniques treat atlantoaxial instability, ranging from external immobilization to surgery (e.g., Magerl transarticular screw fixation and the Harms/Goel C1-C2 rod technique).[
We reviewed the records of 14 patients averaging 62 years of age who underwent atlantoaxial fixation using both C1 lateral mass screws and C1-C2 transarticular screws (2012–2017). All patients had preoperative thin-sliced computerized tomography (CT) scan and/or CT-angiography to confirm the course of the vertebral artery and to detect any anomalies.
After the routine midline approach, the inferior facet of C2 was docked, and drilling was performed through the C1-C2 facet joint to the level of the anterior arch of C1 under fluoroscopy, within the lateral mass of C1. A polyaxial screw, typically 40 mm in length, was placed. Next, the dorsal arch of C1 was exposed laterally. The C2 nerve root was identified and mobilized inferiorly. The lateral part of the C1 arch, which overlies the lateral mass below the sulcus arteriosus, was drilled until the lateral mass was exposed. After drilling at the decorticated C1 lateral mass and under fluoroscopy, a polyaxial screw was inserted. Then, the polyaxial screws were fixed with rods. Bone graft was placed in the interlaminar space or laterally in the facet joint.
The patient's clinical and treatment data are presented in
We were able to demonstrate that the combination of C1 lateral mass screws with C1-C2 transarticular screws is a safe and solid technique for posterior atlantoaxial fixation based on well-established posterior atlantoaxial fixation techniques.
The C1-C2 motion segment has the widest range of movement of any spinal motion segment. This range of motion even increases if components of the C1-C2 motion segment are damaged by trauma, inflammation, neoplasm, or congenital defects. Therefore, atlantoaxial immobilization by instrumentation is challenging.[
The C1 lateral mass screw with C1-C2 transarticular screw is a novel posterior atlantoaxial fixation technique for atlantoaxial instability and is based on established posterior atlantoaxial fixation techniques.[
We conclude that C1 lateral mass and C1-C2 transarticular polyaxial screw rod fixation is a novel and effective surgical technique to achieve immediate rigid immobilization of the C1-C2 motion segment.
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Conflicts of interest
There are no conflicts of interest.
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