Seven Years of Experience With C2 Translaminar Screw Fixation: Clinical Series and Review of the Literature

Neurosurgery ◽  
2011 ◽  
Vol 68 (6) ◽  
pp. 1491-1499 ◽  
Author(s):  
Ian G. Dorward ◽  
Neill M. Wright
Keyword(s):  
Computed Tomography ◽  
Screw Fixation ◽  
Fusion Rate ◽  
Minimal Risk ◽  
Translaminar Screw Fixation ◽  
Flexion Extension ◽  
Translaminar Screw ◽  
Computed Tomography Scans ◽  
C2 Fixation ◽  
Translaminar Screws

Abstract BACKGROUND: C2 translaminar screws offer biomechanical stability similar to that of other C2 fixation methods but with minimal risk to neural and vascular structures. OBJECTIVE: To report our experience with the technique since 2002 and to review the pertinent literature to advance the understanding of C2 translaminar screw fixation. METHODS: Fifty-two consecutive adult patients with disorders requiring axis stabilization were treated with C2 translaminar screws by a single surgeon. All patients underwent preoperative computed tomography scans to confirm the feasibility of screw placement. Patients were followed up with serial flexion/extension radiographs and/or computed tomography scans. RESULTS: The average age in our series was 58.1 years. One hundred three C2 translaminar screws were placed (average length, 28.9 mm). No vascular or neurological injuries occurred. Of 41 patients with sufficient follow-up (average, 13.3 months) to evaluate fusion, 1 instrumentation failure/pseudoarthrosis was observed. Five patients (average age, 78.7 years) died of complications related to medical comorbidities. In the literature, 169 cases of C2 translaminar fixation have been reported, with a fusion rate of 95.3% and no vertebral artery injuries. In biomechanical studies, C2 translaminar screws perform similarly to C2 pedicle screws and may outperform C2 pars screws in intact spine models. With disrupted atlantoaxial ligaments, constructs with C2 translaminar screws may not resist lateral bending as well as those with other screws, although they have more stability than uninstrumented, intact spines. CONCLUSION: This study reports 103 C2 translaminar screws, the largest single-surgeon series to date. C2 translaminar screws are a technically feasible, low-risk option for C2 fixation, with a 97.6% fusion rate in this series.

scholarly journals Biomechanics and Clinical Application of Translaminar Screws Fixation in Spine: A Review of the Literature

2018 ◽  
Vol 9 (2) ◽  
pp. 210-218
Author(s):  
Jimmy J. Chan ◽  
Nicholas Shepard ◽  
Woojin Cho
Keyword(s):  
Computed Tomography ◽  
Clinical Application ◽  
Pediatric Population ◽  
Thoracolumbar Spine ◽  
Surgical Techniques ◽  
Computed Tomography Scan ◽  
Translaminar Screw ◽  
Computed Tomography Scans ◽  
Translaminar Screws ◽  
Tomography Scan

Study Design: Broad narrative review. Objectives: Translaminar screw (TLS) fixation was first described as a salvage technique for fixation of the axial spine. Better understanding of the spine anatomy allows for advancement in surgical techniques and expansion of TLS indications. The goal of this review is to discuss the anatomic feasibility of the TLS fixation in different region of the spine. Methods: A review of the current literatures on the principles, biomechanics, and clinical application of the translaminar screw technique in the axial, subaxial, and thoracolumbar spine. Results: Anatomic feasibility and biomechanical studies have demonstrated that TLS is a safe and strong fixation methods for fusion beyond just the axial spine. However, not all spine segments have wide enough lamina to accept TLS. Preoperative computed tomography scan can help ensure the feasibility and safety of TLS insertion. Recent clinical reports have validated the application of TLS in subaxial spine, thoracic spine, hangman’s fracture, and pediatric population. Conclusions: TLS can be used beyond axial spine; however, TLS insertion is only warranted when the lamina is thick enough to avoid further complications such as breakage. Preoperative computed tomography scans can be used to determine feasibility of such fixation construct.

USE OF AXIAL AND SUBAXIAL TRANSLAMINAR SCREW FIXATION IN THE MANAGEMENT OF UPPER CERVICAL SPINAL INSTABILITY IN A SERIES OF 7 CHILDREN

Neurosurgery ◽  
2009 ◽  
Vol 64 (4) ◽  
pp. 734-739 ◽  
Author(s):  
Roukoz B. Chamoun ◽  
Katherine M. Relyea ◽  
Keyne K. Johnson ◽  
William E. Whitehead ◽  
Daniel J. Curry ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Screw Fixation ◽  
Screw Placement ◽  
Os Odontoideum ◽  
Spinal Instability ◽  
Screw Insertion ◽  
Translaminar Screw Fixation ◽  
Translaminar Screw ◽  
Upper Cervical ◽  
Translaminar Screws

Abstract OBJECTIVE The management of upper cervical spinal instability in children continues to represent a technical challenge. Traditionally, a number of wiring techniques followed by halo orthosis have been applied; however, they have been associated with a high rate of nonunion and poor tolerance for the halo. Alternatively, C1–C2 transarticular screws and C2 pars/pedicle screws allow more rigid fixation, but they are technically demanding and associated with vertebral artery injuries. Recently, C2 translaminar screws have been added to the armamentarium of the pediatric spine surgeon as a technically simple and biomechanically efficient method of fixation. However, subaxial translaminar screws have not been described in the pediatric population. We describe our experience with axial and subaxial translaminar screws in 7 pediatric patients. METHODS Seven pediatric patients with the diagnosis of upper cervical spinal instability required surgical fixation (age, 19 months–14 years; sex, 4 boys and 3 girls; follow-up, 4–21 months; etiology, trauma [3 patients], os odontoideum/os terminale [2 patients], hypoplastic dens [2 patients]). All patients underwent axial and/or subaxial translaminar screw insertion. Iliac crest bone graft was used for fusion in 4 patients; bone morphogenic protein and cancellous morselized allograft was used for fusion in 3 patients. A rigid cervical collar was applied for 12 weeks postoperatively in all cases. No intraoperative image guidance was used for insertion of the translaminar screws. RESULTS All patients had a postoperative computed tomographic scan. Two patients underwent placement of bilateral crossing C2 translaminar screws. Two patients had subaxial translaminar screw placement at C3 and the upper thoracic spine, respectively. Hybrid constructs (a C2 translaminar screw combined with a C2 pars screw) were incorporated in 3 patients. No patients were found to have a breach of the ventral laminar cortex. All patients achieved solid fusion. One patient had a perioperative complication: prolonged dysphagia probably related to C1 lateral mass screw insertion rather than C2 translaminar screw placement. CONCLUSION To our knowledge, this report represents the only series of pediatric patients treated with axial and subaxial translaminar screws. This series shows that axial and subaxial translaminar screw fixation is a viable option for upper cervical spinal fusion in children. The technique is safe and results in adequate fixation with high fusion rates and minimal complications.

Computed Tomography Morphometric Analysis for Translaminar Screw Fixation in the Upper Thoracic Spine of the Pediatric Population

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 555-556
Author(s):  
Akash J. Patel ◽  
Jacob Cherian ◽  
Daniel H. Fulkerson ◽  
Benjamin Davis Fox ◽  
William E. Whitehead ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Thoracic Spine ◽  
Morphometric Analysis ◽  
Screw Fixation ◽  
Pediatric Population ◽  
Upper Thoracic Spine ◽  
Translaminar Screw Fixation ◽  
Translaminar Screw ◽  
Upper Thoracic

Thoracic and lumbar laminoplasty using a translaminar screw: morphometric study and technique

2009 ◽  
Vol 10 (6) ◽  
pp. 603-609 ◽  
Author(s):  
Sung Bae Park ◽  
Tae-Ahn Jahng ◽  
Chi Heon Kim ◽  
Chun Kee Chung
Keyword(s):  
Screw Fixation ◽  
Simulation Software ◽  
Screw Placement ◽  
Morphometric Study ◽  
En Bloc ◽  
Translaminar Screw Fixation ◽  
Number Of Patients ◽  
Translaminar Screw ◽  
Screw Breakage ◽  
Translaminar Screws

Object The aim of this study was to describe a novel technique for laminoplasty in which translaminar screws are used in the thoracic and lumbar spine. Methods The authors first performed a morphometric study in 20 control individuals using 3D reconstructed CT scans and spine simulation software to measure the lengths and diameters of the spaces available for translaminar screw placement from the T-1 to S-1. Based on the results of the morphometric study, the authors then attempted translaminar screw fixation in 5 patients (April 2007–July 2007) after en bloc laminectomy in the thoracic and lumbar regions. All patients had intradural lesions: 3 schwannomas, 1 cavernoma, and 1 arachnoid cyst. Results The morphometric study in control individuals revealed that the safe trajectories for simulated screws measured 25–30 mm in length and 8–11 mm in diameter in the thoracic region (T1–12) and 26–34 mm in length and 6–7 mm in diameter in the lumbosacral region (L1–S1). This morphometric and simulation study showed that translaminar screw placement would be possible in practice. Five patients underwent en bloc laminoplasty and translaminar screw fixation in which the screws measured 2.7 mm in diameter and 24 or 26 mm in length. Sixteen attempts at translaminar fixation were made in 8 vertebrae. Fourteen translaminar screws were successfully placed at the thoracic and lumbar levels. Two microplates had to be used because the laminae were too thin and narrow after further laminectomy with undercutting. There were no complications associated with the translaminar screws. The mean follow-up period was 14.5 months. There was no screw breakage or displacement. Solid osseous fusion was documented in 2 patients who underwent CT scanning 15 months postoperatively. Conclusions The authors found that the laminoplasty and translaminar screw technique is feasible in the thoracic and lumbar regions, but further studies are needed to analyze the biomechanical effects and long-term outcomes in a large number of patients.

Translaminar screw fixation in the subaxial pediatric cervical spine

2008 ◽  
Vol 2 (6) ◽  
pp. 386-390 ◽  
Author(s):  
Andrew Jea ◽  
Keyne K. Johnson ◽  
William E. Whitehead ◽  
Thomas G. Luerssen
Keyword(s):  
Pediatric Patients ◽  
Screw Fixation ◽  
Spinal Instrumentation ◽  
Careful Analysis ◽  
Preoperative Imaging ◽  
Rigid Fixation ◽  
Translaminar Screw Fixation ◽  
Translaminar Screw ◽  
Lateral Mass Screws ◽  
Translaminar Screws

The use of spinal instrumentation to stabilize the occipitocervical junction in pediatric patients has increased and evolved in recent years. Wiring techniques have now given way to screw-rod or screw-plate techniques with or without postoperative external immobilization. Although C-2 translaminar screws have been used in these constructs, subaxial translaminar screws have not, to date, been described in either the pediatric or adult patient populations. The authors describe the feasibility of translaminar screw placement in the C-3 lamina. Rigid fixation with translaminar screws offers an alternative to subaxial fixation with lateral mass screws, allowing for formation of biomechanically sound spinal constructs and minimizing potential neurovascular morbidity. Their use requires careful analysis of preoperative imaging studies, intact posterior elements, and avoidance of violation of the inner laminar wall.

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