Persistent First Intersegmental Vertebral Artery in Association With Type II Odontoid Fracture: Surgical Treatment Utilizing a Novel C1 Posterior Arch Screw

Neurosurgery ◽  
2010 ◽  
Vol 67 (1) ◽  
pp. E210-E211 ◽  
Author(s):  
Margaret A. Carmody ◽  
Michael D. Martin ◽  
Christopher E. Wolfla
Keyword(s):  
Vertebral Artery ◽  
Degenerative Spondylolisthesis ◽  
Odontoid Fracture ◽  
Posterior Fixation ◽  
Posterior Arch ◽  
Type Ii ◽  
Lateral Mass ◽  
Congenital Fusion ◽  
Pars Interarticularis ◽  
Lateral Mass Screws

Abstract OBJECTIVE AND IMPORTANCE Posterior cervical stabilization for cervical fractures is common, and numerous techniques for fixation have been described. This case describes the novel usage of C1 laminar screws due to a persistent intersegmental artery and congenital fusion of C2–C3. CLINICAL PRESENTATION A 64-year-old woman presented with loss of consciousness after falling down a flight of stairs. Initial CT scan showed a type II odontoid fracture with significant malalignment, as well as an anomalous congenital fusion of C2–C3 and degenerative spondylolisthesis of C3 to C4. CT angiogram demonstrated bilateral persistent first intersegmental arteries coursing through the C1–C2 neural foramina. INTERVENTION The patient underwent C2 fracture reduction and posterior C1–C4 fusion. C1 posterior arch screws were placed due to the patient's anomalous vertebral artery location. The construct was anchored caudally by C2 pars interarticularis screws and C4 lateral mass screws. The patient experienced an excellent neurologic and radiographic outcome at 12.5 months. CONCLUSION Posterior fixation for fractures of the cervical spine is common; however, the use of C1 posterior arch screws for fractures has not previously been described. The presence of a persistent intersegmental course of the vertebral artery, a rare but reported anomaly, should be regarded as a contraindication to placement of C1 lateral mass screws and necessitates careful consideration of the available surgical options.

scholarly journals Posterior spinal fusion using a unilateral C1 posterior arch screw and a C2 laminar screw for atlantoaxial fracture dislocation

2019 ◽  
Vol 7 ◽  
pp. 2050313X1984927 ◽  
Author(s):  
Yuichi Ono ◽  
Naohisa Miyakoshi ◽  
Michio Hongo ◽  
Yuji Kasukawa ◽  
Yoshinori Ishikawa ◽  
...  
Keyword(s):  
Pedicle Screws ◽  
Fracture Site ◽  
Fracture Dislocation ◽  
Posterior Arch ◽  
Lateral Mass ◽  
Laminar Screw ◽  
Upper Cervical ◽  
Lateral Mass Screws ◽  
The Right ◽  
C2 Laminar Screw

Introduction: C1 lateral mass screws and C2 pedicle screws are usually chosen to fix atlantoaxial (C1–C2) instability. However, there are a few situations in which these screws are difficult to use, such as in a case with a fracture line at the screw insertion point and bleeding from the fracture site. A new technique using a unilateral C1 posterior arch screw and a C2 laminar screw combined with a contralateral C1 lateral mass screws–C2 pedicle screws procedure for upper cervical fixation is reported. Case Report: A 24-year-old woman had an irreducible C1–C2 anterior dislocation with a type III odontoid fracture on the right side due to a traffic accident. The patient underwent open reduction and posterior C1–C2 fixation. On the left side, a C1 lateral mass screws and a C2 pedicle screws were placed. Because there was bleeding from the fracture site and a high-riding vertebral artery was seen on the right side, a C1 posterior arch screw and a C2 laminar screw were chosen. Eight months after the surgery, computed tomography scans showed healing of the odontoid fracture with anatomically correct alignment. Conclusions: Although there have been few comparable studies, fixation with unilateral C1 posterior arch screw–C2 laminar screw could be a beneficial choice for surgeries involving the upper cervical region in patients with fracture dislocation or arterial abnormalities.

Atlantoaxial stabilization using multiaxial C-1 posterior arch screws

2008 ◽  
Vol 9 (6) ◽  
pp. 522-527 ◽  
Author(s):  
Michael B. Donnellan ◽  
Ioannis G. Sergides ◽  
William R. Sears
Keyword(s):  
Clinical Results ◽  
Posterior Arch ◽  
Lateral Mass ◽  
Normal Anatomy ◽  
Novel Technique ◽  
Vertebral Arteries ◽  
Fixation Techniques ◽  
Atlantoaxial Fixation ◽  
Atlantoaxial Stabilization ◽  
Lateral Mass Screws

The authors present a novel technique of atlantoaxial fixation using multiaxial C-1 posterior arch screws. The technique involves the insertion of bilateral multiaxial C-1 posterior arch screws, which are connected by crosslinked rods to bilateral multiaxial C-2 pars screws. The clinical results are presented in 3 patients in whom anomalies of the vertebral arteries, C-1 lateral masses, and/or posterior arch of C-1 presented difficulty using existing fixation techniques with transarticular screws, C-1 lateral mass screws, or posterior wiring. The C-1 posterior arch screws achieved solid fixation and their insertion appeared to be technically less demanding than that of transarticular or C-1 lateral mass screws. This technique may reduce the risk of complications compared with existing techniques, especially in patients with anatomical variants of the vertebral artery, C-1 lateral masses, or C-1 posterior arch. This technique may prove to be an attractive fixation option in patients with normal anatomy.

Operative nuances to safeguard anomalous vertebral artery without compromising the surgery for congenital atlantoaxial dislocation: untying a tough knot between vessel and bone

2014 ◽  
Vol 20 (1) ◽  
pp. 5-10 ◽  
Author(s):  
Pravin Salunke ◽  
Sameer Futane ◽  
Sushant K. Sahoo ◽  
Mandeep S. Ghuman ◽  
Niranjan Khandelwal
Keyword(s):  
Vertebral Artery ◽  
Preoperative Evaluation ◽  
Posterior Inferior Cerebellar Artery ◽  
Vascular Anatomy ◽  
Craniovertebral Junction ◽  
Atlantoaxial Dislocation ◽  
Lateral Mass ◽  
3D Ct ◽  
Ct Angiogram ◽  
Pars Interarticularis

Object Stabilization of the craniovertebral junction (CVJ) by using lateral masses requires extensive dissection. The vertebral artery (VA) is commonly anomalous in patients with congenital CVJ anomaly. Such a vessel is likely to be injured during dissection or screw placement. In this study the authors discuss the importance of preoperative evaluation and certain intraoperative steps that reduce the chances of injury to such vessels. Methods A 3D CT angiogram was obtained in 15 consecutive patients undergoing surgery for congenital atlantoaxial dislocation. The course of the VA and its relationship to the C1–2 facets was studied in these patients. The anomalous VA was exposed intraoperatively, facet surfaces were drilled in all, and the screws were placed according to the disposition of the vessel. Results A skeletal anomaly was found in all 10 patients who had an anomalous VA. Four types of variations were noted: 1) the first intersegmental artery in 5 patients (bilateral in 1); 2) fenestration of VA in 1 patient; 3) anomalous posterior inferior cerebellar artery crossing the C1–2 joint in 1 patient; and 4) medial loop of VA in 5 patients. The anomalous vessel was dissected and the facet surfaces were drilled in all. The C-1 lateral mass screw was placed under vision, taking care not to compromise the anomalous vessel, although occipital screws or sublaminar wires were used in the initial cases. A medial loop of the VA necessitated placement of transpedicular or C-2 lateral mass screws instead of pars interarticularis screws. The anomalous vessel was injured in none. Conclusions Preoperative 3D CT angiography is a highly useful method of imaging the artery in patients with CVJ anomaly. It helps in identifying the anomalous VA or its branch and its relationship to the C1–2 facets. The normal side should be surgically treated and distracted first because this helps in opening the abnormal side, aiding in dissection. In the posterior approach the C-2 nerve root is always encountered before the anomalous vessel. The defined vascular anatomy helps in choosing the type of screw. The vessel should be mobilized so as to aid the drilling of facets and the placement of screws and spacers under vision, avoiding its injury (direct or indirect) or compression. With these steps, C1–2 (short segment) rigid fusion can be achieved despite the presence of anomalous VA.

Biomechanical comparison of the pullout strengths of C1 lateral mass screws and C1 posterior arch screws

2013 ◽  
Vol 13 (12) ◽  
pp. 1892-1896 ◽  
Author(s):  
Christopher M. Zarro ◽  
Steven C. Ludwig ◽  
Adam H. Hsieh ◽  
Charles N. Seal ◽  
Daniel E. Gelb
Keyword(s):  
Posterior Arch ◽  
Lateral Mass ◽  
Lateral Mass Screws ◽  
Biomechanical Comparison

Traumatic Posterolateral C1-C2 Dislocation Complicated with Locked Lateral Mass and Type II Odontoid Fracture—5-Year Follow-up

2018 ◽  
Vol 114 ◽  
pp. 330-334 ◽  
Author(s):  
Zhu Minyu ◽  
Wu Shiyang ◽  
Chandoo Suraj ◽  
Huang Kelun ◽  
Lin Chaowei ◽  
...  
Keyword(s):  
Odontoid Fracture ◽  
Type Ii ◽  
Lateral Mass

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.

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