Operative management for atlantoaxial instability in case of bilateral high-riding vertebral artery

2008 ◽  
Vol 129 (2) ◽  
pp. 177-182 ◽  
Author(s):  
Dorothea Daentzer
Keyword(s):  
Vertebral Artery ◽  
Operative Management ◽  
Atlantoaxial Instability

Injuries to the Neck

2015 ◽  
Author(s):  
David H. Wisner ◽  
Joseph M. Galante
Keyword(s):  
Vertebral Artery ◽  
Carotid Arteries ◽  
Life Support ◽  
Jugular Vein ◽  
Penetrating Trauma ◽  
Operative Management ◽  
Advanced Trauma Life Support ◽  
Neck Trauma ◽  
Anatomical Structures ◽  
Initial Management

Injuries to the neck can be the result of blunt and penetrating trauma. Both mechanisms can cause devastating injuries, with high associated rates of morbidity and mortality. Airway management in trauma does not differ based on the mechanism of injury, and so the initial priority is to ensure an adequate airway through cricothyrotomy or tracheotomy. For penetrating neck trauma, initial management is evaluated in accordance with Advanced Trauma Life Support (ATLS) guidelines. Thereafter, the management of penetrating trauma of the stable patients is provided and includes carotid artery exploration and repair, vertebral artery exploration and repair, endovascular repair, jugular vein injuries, treatment of the pharynx and esophagus, and treatment of the larynx and trachea. Blunt trauma is described and includes injuries to the aerodigestive tract and cerebrovascular and vertebral injuries. Figures show an algorithm outlining operative management of known or suspected injuries to the carotid arteries, jugular vein, pharynx, and esophagus; the three separate zones of the neck; common incisions made along the sternocleidomastoid muscle; important anatomical structures of the neck; and an algorithm outlining management of known injuries to the vertebral artery. This chapter contains 31 references.

Safeguarding the Anomalous Vertebral Artery While Dissecting, Drilling, and Instrumentation of C1-2 Joint for Congenital Atlantoaxial Dislocation: 2-Dimensional Operative Video

2018 ◽  
Vol 15 (5) ◽  
pp. E57-E57 ◽  
Author(s):  
Pravin Salunke ◽  
Sushanta K Sahoo
Keyword(s):  
Cervical Spine ◽  
Informed Consent ◽  
Vertebral Artery ◽  
Atlantoaxial Dislocation ◽  
Atlantoaxial Instability ◽  
The Third ◽  
Abnormal Anatomy

Abstract The pathology in congenital atlantoaxial instability is usually in C1-2 joints. Addressing the joints appears to be the most rationale approach. The joints are usually approached posteriorly, manipulated, and fused. Understanding the normal and abnormal anatomy is important. Normally, the third segment of the vertebral artery courses lateral to the C1-2 joint. However, in about 20% of the cases with complex congenital craniovertberal junction anomalies the artery crosses the joint posteriorly. The artery in such cases may be injured while joint manipulation and instrumentation with disastrous consequences. Alternatively, occipital squama can be fused to the cervical spine. However, this requires fusion of multiple segments affecting the neck movements significantly. An anomalous vertebral artery can be dissected, mobilized, and safeguarded while dissecting, manipulating, and fusing the C1-2 joint. In this operative video, authors have highlighted the technique to safeguard the anomalous vertebral artery during joint manipulation.  Proper informed consent was obtained from the patient.

scholarly journals C1-C2 screw fixation in the patient with anomalous course of vertebral artery: Case report

2019 ◽  
Vol 76 (5) ◽  
pp. 555-558 ◽  
Author(s):  
Drazen Ivetic ◽  
Goran Pavlicevic ◽  
Branislav Antic
Keyword(s):  
Case Report ◽  
Vertebral Artery ◽  
Screw Fixation ◽  
Atlantoaxial Instability ◽  
Complicated Structure ◽  
Neurological Improvement ◽  
Degenerative Disorders ◽  
Translaminar Screw ◽  
Atlantoaxial Fixation ◽  
Alternative Fixation

Introduction. The atlantoaxial complex is a very complicated structure and open reduction of C1-C2 subluxation is very demanding. Atlantoaxial instability may result from the traumatic, inflammatory, neoplastic, congenital or degenerative disorders. Anatomy of the vertebral artery is essential for surgical approach and sometimes the placement of C2 pedicle screw is not possible. In these instances, the translaminar screw placement in C2 can provide an alternative fixation point in C2, without threatening injury to the vertebral artery. Case report. We presented 54- year-old patient with cervical myelopathy according to traumatic atlantoaxial subluxation. Computed tomography angiography showed a bilateral vertebral artery anomaly of ?high-riding? type. The patient was operated and the posterior C1-C2 screws fixation was used. Due to the vertebral artery anomaly C2 screws were translaminary inserted. Complete reduction of C1-C2 subluxation and excellent neurological improvement were achieved. Conclusion. Surgical treatment of C1-C2 subluxation is very challenging. Many techniques of atlantoaxial fixation have been developed. The use of C2 translaminar screw is an alternative method of fixation in the treatment of atlantoaxial instability, especially in cases with the vertebral artery anomaly.

Atlantoaxial Fusion Using C1 Sublaminar Cables and C2 Translaminar Screws

2017 ◽  
Vol 14 (6) ◽  
pp. 647-653 ◽  
Author(s):  
Alexandra M Giantini Larsen ◽  
Benjamin L Grannan ◽  
Robert M Koffie ◽  
Jean-Valéry Coumans
Keyword(s):  
Vertebral Artery ◽  
Nerve Root ◽  
Limited Range ◽  
Atlantoaxial Instability ◽  
Posterior Arch ◽  
Hardware Failure ◽  
Risk Of Injury ◽  
Limited Range Of Motion ◽  
C2 Nerve Root ◽  
Translaminar Screws

Abstract BACKGROUND Atlantoaxial instability, which can arise in the setting of trauma, degenerative diseases, and neoplasm, is often managed surgically with C1–C2 arthrodesis. Classical C1–C2 fusion techniques require placement of instrumentation in close proximity to the vertebral artery and C2 nerve root. OBJECTIVE To report a novel C1–C2 fusion technique that utilizes C2 translaminar screws and C1 sublaminar cables to decrease the risk of injury to the vertebral artery and C2 nerve root. METHODS To facilitate fixation to the atlas, while minimizing the risk of injury to the vertebral artery and to the C2 nerve root, we sought to determine the feasibility of using a soft cable around the C1 arch and affixing it to a rod connected to C2 laminar screws. We reviewed our experience in 3 patients. RESULTS We used this technique in patients in whom we anticipated difficult C1 screw placement. Three patients were identified through a review of the senior author's cases. Atlantoaxial instability was associated with trauma in 2 patients and chronic degenerative changes in 1 patient. Common symptoms on presentation included pain and limited range of motion. All patients underwent C1–C2 fusion with C2 translaminar screws with sublaminar cable harnessing of the posterior arch of C1. There were no reports of postoperative complications or hardware failure. CONCLUSION We demonstrate a novel, technically straightforward approach for C1–C2 fusion that minimizes risk to the vertebral artery and to the C2 nerve root, while still allowing for semirigid fixation in instances of both traumatic and chronic degenerative atlantoaxial instability.

scholarly journals Posterior atlantoaxial fixation with new subfacetal axis screw trajectory avoiding vertebral artery with customized variable screw placement plate and screws to enhance biomechanics of fixation

2020 ◽  
Vol 3 (1) ◽  
pp. V10
Author(s):  
Sushil Patkar
Keyword(s):  
Vertebral Artery ◽  
Facet Joint ◽  
Articular Surface ◽  
Standard Of Care ◽  
Screw Placement ◽  
Atlantoaxial Instability ◽  
Technological Advances ◽  
Atlantoaxial Fixation ◽  
Screw Position ◽  
Developed World

Fixation for atlantoaxial dislocation is a challenging issue, and posterior C1 lateral mass and C2 pars–pedicle screw plate–rod construct is the standard of care for atlantoaxial instability. However, vertebral artery injury remains a potential complication. Recent literature has focused on intraoperative navigation, the O-arm, 3D printing, and recently use of robots for perfecting the trajectory and screw position to avoid disastrous injury to the vertebral artery and enhance the rigidity of fixation. These technological advances increase the costs of the surgery and are available only in select centers in the developed world.Review of the axis bone anatomy and study of the stress lines caused by weight transmission reveal that the bone below the articular surface of the superior facet is consistently dense as it lies along the line of weight transmission A new trajectory for the axis screw 3–5 mm below the midpoint of the facet joint and directed downward and medially avoids the course of the vertebral artery and holds the axis rigidly. Divergent screw constructs are biomechanically stronger. Variable screw placement (VSP) plates with long shaft screws permit manipulation of the vertebrae and realignment of the facets to the correct reduced position with fixation in the compression mode.The video can be found here: https://youtu.be/E1msiKjM-aA

Morphometric Anatomy of the Posterior Aspect of the Atlas and the Vertebral Artery Groove in Relation to Lateral Mass Screw Placement

2021 ◽  
Author(s):  
Selda Aksoy ◽  
Bulent Yalcin
Keyword(s):  
Vertebral Artery ◽  
Screw Placement ◽  
Atlantoaxial Instability ◽  
Posterior Arch ◽  
Lateral Mass ◽  
Lateral Mass Screw ◽  
Entry Zone ◽  
Mean Width ◽  
The Mean ◽  
The Right

Abstract Background Atlantoaxial instability is an important disorder that causes serious symptoms such as difficulties in walking, limited neck mobility, sensory deficits, etc. Atlantal lateral mass screw fixation is a surgical technique that has gained important recognition and popularity. Because accurate drilling area for screw placement is of utmost importance for a successful surgery, we aimed to investigate morphometry of especially the posterior part of C1. Methods One hundred and fifty-eight human adult C1 dried vertebrae were obtained. Measurements were performed directly on dry atlas vertebrae, and all parameters were measured by using a digital caliper accurate to 0.01 mm for linear measurements. Results The mean distance between the tip of the posterior arch and the medial inner edge of the groove was found to be 10.59 ± 2.26 and 10.49 ± 2.20 mm on the right and left, respectively. The mean distance between the tip of the posterior arch and the anterolateral outer edge of the groove was 21.27 ± 2.28 mm (right: 20.96 ± 2.22 mm; left: 21.32 ± 2.27 mm). The mean height of the screw entry zone on the right and left sides, respectively, were 3.86 ± 0.81 and 3.84 ± 0.77 mm. The mean width of the screw entry zone on both sides was 13.15 ± 1.17 and 13.25 ± 1.3 mm. Conclusion Our result provided the literature with a detailed database for the morphometry of C1, especially in relation to the vertebral artery groove. We believe that the data in the present study can help surgeons to adopt a more accurate approach in terms of accurate lateral mass screw placement in atlantoaxial instability.

The association between atlantoaxial instability and anomalies of vertebral artery and axis

2021 ◽  
Author(s):  
Chan Woong Byun ◽  
Dong-Ho Lee ◽  
Sehan Park ◽  
Choon Sung Lee ◽  
Chang Ju Hwang ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Atlantoaxial Instability

scholarly journals Risk of the high-riding variant of vertebral arteries at C2 is increased over twofold in rheumatoid arthritis: a meta-analysis

2020 ◽  
Author(s):  
Tomasz Klepinowski ◽  
Jagoda Cembik ◽  
Leszek Sagan
Keyword(s):  
Rheumatoid Arthritis ◽  
Relative Risk ◽  
Vertebral Artery ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Atlantoaxial Instability ◽  
Vertebral Arteries ◽  
Group A ◽  
Group B

Abstract Rheumatoid arthritis (RA) might lead to atlantoaxial instability requiring transpedicular or transarticular fusion. High-riding vertebral artery (HRVA) puts patients at risk of injuring the vessel. RA is hypothesized to increase a risk of HRVA. However, to date, no relative risk (RR) has been calculated in order to quantitatively determine a true impact of RA as its risk factor. To the best of our knowledge, this is the first attempt to do so. All major databases were scanned for cohort studies combining words “rheumatoid arthritis” and “high-riding vertebral artery” or synonyms. RA patients were qualified into the exposed group (group A), whereas non-RA subjects into the unexposed group (group B). Risk of bias was explored by means of Newcastle-Ottawa Scale. MOOSE checklist was followed to ensure correct structure. Fixed-effects model (inverse variance) was employed. Four studies with a total of 308 subjects were included in meta-analysis. One hundred twenty-five subjects were in group A; 183 subjects were in group B. Mean age in group A was 62,1 years, whereas in group B 59,9 years. The highest risk of bias regarded “comparability” domain, whereas the lowest pertained to “selection” domain. The mean relative risk of HRVA in group A (RA) as compared with group B (non-RA) was as follows: RR = 2,11 (95% CI 1,47–3,05), I2 = 15,19%, Cochrane Q = 3,54 with overall estimate significance of p < 0,001. Rheumatoid arthritis is associated with over twofold risk of developing HRVA, and therefore, vertebral arteries should be meticulously examined preoperatively before performing craniocervical fusion in every RA patient.

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