C-1 Lateral Mass Screw Fixation in Children With Atlantoaxial Instability: Case Series and Technical Report

2010 ◽  
Vol 23 (7) ◽  
pp. 474-479 ◽  
Author(s):  
Rasesh Desai ◽  
Charles B. Stevenson ◽  
Alvin H. Crawford ◽  
Abubakar Atiq Durrani ◽  
Francesco T. Mangano
Keyword(s):  
Screw Fixation ◽  
Case Series ◽  
Atlantoaxial Instability ◽  
Lateral Mass ◽  
Lateral Mass Screw ◽  
Technical Report

Stabilization of the atlantoaxial complex via C-1 lateral mass and C-2 pedicle screw fixation in a multicenter clinical experience in 102 patients: modification of the Harms and Goel techniques

2008 ◽  
Vol 8 (3) ◽  
pp. 222-229 ◽  
Author(s):  
Henry E. Aryan ◽  
C. Benjamin Newman ◽  
Eric W. Nottmeier ◽  
Frank L. Acosta ◽  
Vincent Y. Wang ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Case Series ◽  
Pedicle Screws ◽  
Joint Space ◽  
Atlantoaxial Instability ◽  
Lateral Mass ◽  
X Ray ◽  
Harms Technique ◽  
Flexion And Extension

Object Stabilization of the atlantoaxial complex has proven to be very challenging. Because of the high mobility of the C1–2 motion segment, fusion rates at this level have been substantially lower than those at the subaxial spine. The set of potential surgical interventions is limited by the anatomy of this region. In 2001 Jürgen Harms described a novel technique for individual fixation of the C-1 lateral mass and the C-2 pedicle by using polyaxial screws and rods. This method has been shown to confer excellent stability in biomechanical studies. Cadaveric and radiographic analyses have indicated that it is safe with respect to osseous and vascular anatomy. Clinical outcome studies and fusion rates have been limited to small case series thus far. The authors reviewed the multicenter experience with 102 patients undergoing C1–2 fusion via the polyaxial screw/rod technique. They also describe a modification to the Harms technique. Methods One hundred two patients (60 female and 42 male) with an average age of 62 years were included in this analysis. The average follow-up was 16.4 months. Indications for surgery were instability at the C1–2 level, and a chronic Type II odontoid fracture was the most frequent underlying cause. All patients had evidence of instability on flexion and extension studies. All underwent posterior C-1 lateral mass to C-2 pedicle or pars screw fixation, according to the method of Harms. Thirty-nine patients also underwent distraction and placement of an allograft spacer into the C1–2 joint, the authors' modification of the Harms technique. None of the patients had supplemental sublaminar wiring. Results All but 2 patients with at least a 12-month follow-up had radiographic evidence of fusion or lack of motion on flexion and extension films. All patients with an allograft spacer demonstrated bridging bone across the joint space on plain x-ray films and computed tomography. The C-2 root was sacrificed bilaterally in all patients. A postoperative wound infection developed in 4 patients and was treated conservatively with antibiotics and local wound care. One patient required surgical debridement of the wound. No patient suffered a neurological injury. Unfavorable anatomy precluded the use of C-2 pedicle screws in 23 patients, and thus, they underwent placement of pars screws instead. Conclusions Fusion of C1–2 according to the Harms technique is a safe and effective treatment modality. It is suitable for a wide variety of fracture patterns, congenital abnormalities, or other causes of atlantoaxial instability. Modification of the Harms technique with distraction and placement of an allograft spacer in the joint space may restore C1–2 height and enhance radiographic detection of fusion by demonstrating a graft–bone interface on plain x-ray films, which is easier to visualize than the C1–2 joint.

Atlantoaxial stabilization with the use of C1–3 lateral mass screw fixation

2006 ◽  
Vol 5 (2) ◽  
pp. 172-177 ◽  
Author(s):  
Eric M. Horn ◽  
Jonathan S. Hott ◽  
Randall W. Porter ◽  
Nicholas Theodore ◽  
Stephen M. Papadopoulos ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Intraoperative Complications ◽  
Atlantoaxial Instability ◽  
Lateral Mass ◽  
Lateral Mass Screw ◽  
Transarticular Screw ◽  
Transarticular Screw Fixation ◽  
Cervical Orthosis ◽  
Atlantoaxial Stabilization

✓ Atlantoaxial stabilization has evolved from simple posterior wiring to transarticular screw fixation. In some patients, however, the course of the vertebral artery (VA) through the axis varies, and therefore transarticular screw placement is not always feasible. For these patients, the authors have developed a novel method of atlantoaxial stabilization that does not require axial screws. In this paper, they describe the use of this technique in the first 10 cases. Ten consecutive patients underwent the combined C1–3 lateral mass–sublaminar axis cable fixation technique. The mean age of the patients was 62.6 years (range 23–84 years). There were six men and four women. Eight patients were treated after traumatic atlantoaxial instability developed (four had remote trauma and previous nonunion), whereas in the other two atlantoaxial instability was caused by arthritic degeneration. All had VA anatomy unsuitable to traditional transarticular screw fixation. There were no intraoperative complications in any of the patients. Postoperative computed tomography studies demonstrated excellent screw positioning in each patient. Nine patients were treated postoperatively with the aid of a rigid cervical orthosis. The remaining patient was treated using a halo fixation device. One patient died of respiratory failure 2 months after surgery. Follow-up data (mean follow-up duration 13.1 months) were available for seven of the remaining nine patients and demonstrated a stable construct with fusion in each patient. The authors present an effective alternative method in which C1–3 lateral mass screw fixation is used to treat patients with unfavorable anatomy for atlantoaxial transarticular screw fixation. In this series of 10 patients, the method was a safe and effective way to provide stabilization in these anatomically difficult patients.

The height for screw index (HSI) predicts the development of C2 nerve dysfunction associated with C1 lateral mass screw fixation for atlantoaxial instability

2014 ◽  
Vol 23 (5) ◽  
pp. 1092-1098 ◽  
Author(s):  
Da-Geng Huang ◽  
Ding-Jun Hao ◽  
Yong-Hong Jiang ◽  
Yue Cheng ◽  
Jun-Wei Pan ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Atlantoaxial Instability ◽  
Lateral Mass ◽  
Lateral Mass Screw ◽  
Nerve Dysfunction ◽  
C1 Lateral Mass Screw

Combined C1-C2 Transarticular with C1 Lateral Mass Screw Fixation for the Treatment of Atlantoaxial Instability: A Single Center Experience

2016 ◽  
Vol 3 (4) ◽  
pp. 133-139 ◽  
Author(s):  
Murtuza Sikander ◽  
Sean Martin ◽  
Bassam Dabbous ◽  
Stewart Griffiths ◽  
Sumit Karia ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Atlantoaxial Instability ◽  
Lateral Mass ◽  
Lateral Mass Screw ◽  
Single Center ◽  
Single Center Experience ◽  
C1 Lateral Mass Screw

scholarly journals Transoral digital reduction of complete anterior odontoid dislocation followed by fiducial-based navigated transcondylar screw fixation: illustrative case

2022 ◽  
Vol 3 (3) ◽  
Keyword(s):  
Spinal Fusion ◽  
Screw Fixation ◽  
Treatment Options ◽  
Pedicle Screws ◽  
Craniocervical Junction ◽  
Atlantoaxial Instability ◽  
Illustrative Case ◽  
Trauma Patients ◽  
Lateral Mass ◽  
Craniocervical Instability

BACKGROUND Posterior atlantoaxial dislocations (i.e., complete anterior odontoid dislocation) without C1 arch fractures are a rare hyperextension injury most often found in high-velocity trauma patients. Treatment options include either closed or open reduction and optional spinal fusion to address atlantoaxial instability due to ligamentous injury. OBSERVATIONS A 60-year-old male was struck while on his bicycle by a truck and sustained an odontoid dislocation without C1 arch fracture. Imaging findings additionally delineated a high suspicion for craniocervical instability. The patient had neurological issues due to both a head injury and ischemia secondary to an injured vertebral artery. He was stabilized and transferred to our facility for definitive neurosurgical care. LESSONS The patient underwent a successful transoral digital closed reduction and posterior occipital spinal fusion via a fiducial-based transcondylar, C1 lateral mass, C2 pedicle, and C3 lateral mass construct. This unique reduction technique has not been recorded in the literature before and avoided potential complications of overdistraction and the need for odontoidectomy. Furthermore, the use of bone fiducials for navigated screw fixation at the craniocervical junction is a novel technique and recommended particularly for placement of technically demanding transcondylar screws and C2 pedicle screws where pars anatomy is potentially unfavorable.

The Surgical Treatment of the Cervical Myelopathy with Laminectomy and Posterior Fusion by using Lateral Mass Screw Fixation

2009 ◽  
Vol 44 (1) ◽  
pp. 123
Author(s):  
Kyung-Soo Suk ◽  
Ki-Tack Kim ◽  
Jung-Hee Lee ◽  
Sang-Hun Lee ◽  
Jin-Soo Kim ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Cervical Myelopathy ◽  
Screw Fixation ◽  
Posterior Fusion ◽  
Lateral Mass ◽  
Lateral Mass Screw

C2 Nerve Root Transection During C1 Lateral Mass Screw Fixation

Neurosurgery ◽  
2014 ◽  
Vol 74 (5) ◽  
pp. 475-481 ◽  
Author(s):  
Michael C. Dewan ◽  
Saniya S. Godil ◽  
Stephen K. Mendenhall ◽  
Clinton J. Devin ◽  
Matthew J. McGirt
Keyword(s):  
Nerve Root ◽  
Screw Fixation ◽  
Neck Disability Index ◽  
Occipital Neuralgia ◽  
Lateral Mass ◽  
Negative Consequences ◽  
Lateral Mass Screw ◽  
Patient Reported ◽  
C2 Nerve Root ◽  
C1 Lateral Mass Screw

Abstract BACKGROUND: Sectioning of the C2 nerve root allows for direct visualization of the C1-2 joint and may facilitate arthrodesis. OBJECTIVE: To determine the clinical and functional consequences of C2 nerve root sectioning during placement of C1 lateral mass screws. METHODS: All patients undergoing C1 lateral mass screw fixation were included in this prospective study. A standard questionnaire was used to determine the severity of occipital numbness/pain and its effect on quality of life (QOL). Domains of the neck disability index were used to assess the disability related to C2 symptoms. RESULTS: A total of 28 patients were included (C2 transection, 8; C2 preservation, 20). A trend of decreased blood loss and length of surgery was observed in the C2 transection cohort. Occipital numbness was reported by 4 (50.0%) patients after C2 transection. Occipital neuralgia was reported by 7 (35.0%) patients with C2 preservation. None of the patients with numbness after C2 transection reported being “bothered” by it. All patients with occipital neuralgia after C2 sparing reported being “bothered” by it, and 57.1% reported a moderate to severe effect on QOL. The use of medication was reported by 5 (71.4%) patients with neuralgia vs none with numbness. Mean disability was significantly higher with neuralgia vs numbness (P = .016). CONCLUSION: C2 nerve root transection is associated with increased occipital numbness but this has no effect on patient-reported outcomes and QOL. C2 nerve root preservation can be associated with occipital neuralgia, which has a negative impact on patient disability and QOL. C2 nerve root transection has no negative consequences during C1-2 stabilization.

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