Biomechanical Comparison of Two Atlantoaxial Arthrodeses in a Cadaveric Spine Model: Transarticular Screw Fixation Versus Screw and Rod Fixation

2002 ◽  
Author(s):  
V. K. Goel ◽  
H. Kuroki ◽  
S. Holekamp ◽  
V. Pitka¨nen ◽  
S. Rengachary ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Screw Fixation ◽  
Atlantoaxial Instability ◽  
Transarticular Screw ◽  
Transarticular Screw Fixation ◽  
Risk Of Injury ◽  
Spine Model ◽  
Fixation Techniques ◽  
A New Technique ◽  
Biomechanical Comparison

The causes of atlantoaxial instability include trauma, tumor, congenital malformation, or rheumatoid arthritis. Commonly available fixation techniques to stabilize the atlantoaxial complex are several posterior wiring procedures (Brooks fusion, Gallie fusion), transarticular screw procedure (Magerl technique), either alone or in combination. Wiring procedures are obviously easier to accomplish however these do not provide sufficient immobilization across the atlantoaxial complex1,3,4. On the other hand, although transarticular screw fixation (TSF) affords a much stiffer atlantoaxial arthrodesis than posterior wiring procedures. However, TSF has some drawbacks; for example the injury of vertebral artery. Furthermore, body habitus (obesity or thoracic kyphosis) may prevent from achieving the low angle needed for correct placement of screws between C1 and C2. Recently, a new technique of screw and rod fixation (SRF) that minimizes the risk of injury to the vertebral artery and allows intraoperative reduction has been reported2,6. The purpose of this study was to compare the biomechanical stability imparted to the C1 and C2 vertebrae by either TSF or SRF technique in a cadaver model.

Biomechanical Comparison of Four C1 to C2 Rigid Fixative Techniques: Anterior Transarticular, Posterior Transarticular, C1 to C2 Pedicle, and C1 to C2 Intralaminar Screws

Neurosurgery ◽  
2006 ◽  
Vol 58 (3) ◽  
pp. 516-521 ◽  
Author(s):  
Samir B. Lapsiwala ◽  
Paul A. Anderson ◽  
Ashish Oza ◽  
Daniel K. Resnick
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Axial Rotation ◽  
Lateral Bending ◽  
Transarticular Screw ◽  
Transarticular Screw Fixation ◽  
Flexion Extension ◽  
Fixation Techniques ◽  
Biomechanical Comparison ◽  
Cable Fixation

Abstract OBJECTIVE: We performed a biomechanical comparison of several C1 to C2 fixation techniques including crossed laminar (intralaminar) screw fixation, anterior C1 to C2 transarticular screw fixation, C1 to 2 pedicle screw fixation, and posterior C1 to C2 transarticular screw fixation. METHODS: Eight cadaveric cervical spines were tested intact and after dens fracture. Four different C1 to C2 screw fixation techniques were tested. Posterior transarticular and pedicle screw constructs were tested twice, once with supplemental sublaminar cables and once without cables. The specimens were tested in three modes of loading: flexion-extension, lateral bending, and axial rotation. All tests were performed in load and torque control. Pure bending moments of 2 nm were applied in flexion-extension and lateral bending, whereas a 1 nm moment was applied in axial rotation. Linear displacements were recorded from extensometers rigidly affixed to the C1 and C2 vertebrae. Linear displacements were reduced to angular displacements using trigonometry. RESULTS: Adding cable fixation results in a stiffer construct for posterior transarticular screws. The addition of cables did not affect the stiffness of C1 to C2 pedicle screw constructs. There were no significant differences in stiffness between anterior and posterior transarticular screw techniques, unless cable fixation was added to the posterior construct. All three posterior screw constructs with supplemental cable fixation provide equal stiffness with regard to flexion-extension and axial rotation. C1 lateral mass-C2 intralaminar screw fixation restored resistance to lateral bending but not to the same degree as the other screw fixation techniques. CONCLUSION: All four screw fixation techniques limit motion at the C1 to 2 articulation. The addition of cable fixation improves resistance to flexion and extension for posterior transarticular screw fixation.

scholarly journals Reducible Nonunited Type II Odontoid Fracture with Atlantoaxial Instability: Outcomes of Two Different Fixation Techniques

2021 ◽  
Vol 18 (15) ◽  
pp. 7990
Author(s):  
Torphong Bunmaprasert ◽  
Vorapop Trirattanapikul ◽  
Nantawit Sugandhavesa ◽  
Areerak Phanphaisarn ◽  
Wongthawat Liawrungrueang ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Fusion Rate ◽  
Odontoid Fracture ◽  
Atlantoaxial Instability ◽  
Type Ii ◽  
Fixation Technique ◽  
Transarticular Screw ◽  
Transarticular Screw Fixation ◽  
Fixation Techniques ◽  
Surgical Fixation

Displaced nonunited type II odontoid fracture can result in atlantoaxial instability, causing delayed cervical myelopathy. Both Magerl’s C1-C2 transarticular screw fixation technique and Harms-Goel C1-C2 screw-rod segmental fixation technique are effective techniques to provide stability. This study aimed to demonstrate the results of two surgical fixation techniques for the treatment of reducible nonunited type II odontoid fracture with atlantoaxial instability. Medical records of patients with reducible nonunited type II odontoid fracture hospitalized for spinal fusion between April 2007 and April 2018 were reviewed. For each patient, specific surgical fixation, either Magerl’s C1-C2 transarticular screw fixation technique augmented with supplemental wiring or Harms-Goel C1-C2 screw-rod fixation technique, was performed according to our management protocol. We reported the fusion rate, fusion period, and complications for each technique. Of 21 patients, 10 patients were treated with Magerl’s C1-C2 transarticular screw fixation technique augmented with supplemental wiring, and 11 were treated with Harms-Goel C1-C2 screw-rod fixation technique. The bony fusion rate was 100% in both groups. The median time to fusion was 69.7 (95%CI 53.1, 86.3) days in Magerl’s C1-C2 transarticular screw fixation technique and 75.2 (95%CI 51.8, 98.6) days in Harms-Goel C1-C2 screw-rod fixation technique. No severe complications were observed in either group. Displaced reducible, nonunited type II odontoid fracture with cervical myelopathy should be treated by surgery. Both fixation techniques promote bony fusion and provide substantial construct stability.

Atlantoaxial Transarticular Screw Fixation for a High-Riding Vertebral Artery

Spine ◽  
2003 ◽  
Vol 28 (7) ◽  
pp. 666-670 ◽  
Author(s):  
Masashi Neo ◽  
Mutsumi Matsushita ◽  
Yasushi Iwashita ◽  
Tadashi Yasuda ◽  
Takeshi Sakamoto ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Screw Fixation ◽  
Transarticular Screw ◽  
Transarticular Screw Fixation

Anatomical suitability of C1–2 transarticular screw placement in pediatric patients

2000 ◽  
Vol 92 (1) ◽  
pp. 7-11 ◽  
Author(s):  
Douglas L. Brockmeyer ◽  
Julie E. York ◽  
Ronald I. Apfelbaum
Keyword(s):  
Pediatric Patients ◽  
Screw Fixation ◽  
Vascular Complications ◽  
Screw Placement ◽  
Atlantoaxial Instability ◽  
Os Odontoideum ◽  
Transarticular Screw ◽  
Content Type ◽  
Transarticular Screw Fixation ◽  
Fine Print

Object. Craniovertebral instability is a challenging problem in pediatric spinal surgery. Recently, C1–2 transarticular screw fixation has been used to assist in craniovertebral joint stabilization in pediatric patients. Currently there are no available data that define the anatomical suitability of this technique in the pediatric population. The authors report their experience in treating 31 pediatric patients with craniovertebral instability by using C1–2 transarticular screws. Methods. From March 1992 to October 1998, 31 patients who were 16 years of age or younger with atlantooccipital or atlantoaxial instability, or both, were evaluated at our institution. There were 21 boys and 10 girls. Their ages ranged from 4 to 16 years (mean age 10.2 years). The most common causes of instability were os odontoideum (12 patients) and ligamentous laxity (eight patients). Six patients had undergone a total of nine previous attempts at posterior fusion while at outside institutions. All patients underwent extensive preoperative radiological evaluation including fine-slice (1-mm) computerized tomography scanning with multiplanar reconstruction to evaluate the anatomy of the C1–2 joint space. Preoperatively, of the 62 possible C1–2 joint spaces in 31 patients, 55 sides (89%) were considered suitable for transarticular screw placement. In three patients the anatomy was considered unsuitable for bilateral screw placement. In three patients the anatomy was considered inadequate on one side. Fifty-five C1–2 transarticular screws were subsequently placed, and there were no neurological or vascular complications. Conclusions. The authors conclude that C1–2 transarticular screw fixation is technically possible in a large proportion of pediatric patients with craniovertebral instability.

Sign in / Sign up

Export Citation Format

Share Document