Posterior occipitocervical (C0–3) fusion using polyaxial occipital condyle to cervical spine screw and rod fixation: a radiographic and cadaveric analysis

2010 ◽  
Vol 12 (5) ◽  
pp. 509-516 ◽  
Author(s):  
Bruce M. Frankel ◽  
Michael Hanley ◽  
Alex Vandergrift ◽  
Timothy Monroe ◽  
Steven Morgan ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Atlantoaxial Instability ◽  
Occipital Condyle ◽  
Anatomical Studies ◽  
Occipitocervical Fixation ◽  
Polyaxial Screws ◽  
Occipital Condyles ◽  
Ct Studies

Numerous conditions affect the occipitocervical junction requiring treatment with occipitocervical fixation. In this paper the authors present their technique of craniocervical fixation achieved with the cephalad extension of posterior C1–3 polyaxial screw and rods to polyaxial screws placed in the occipital condyles. They retrospectively analyzed occipital condyle morphology obtained from CT analyses of 40 patients with normal cervical spines, evaluated occipital condyle screw placement feasibility in 4 cadavers, and provided a case report of a 70-year-old woman with rheumatoid arthritis, basilar invagination, and atlantoaxial instability who was treated with this novel technique. Based on radiographic analysis of occipital condyle anatomy, they concluded that on average a 3.5-mm-diameter × 20- to 30-mm-long screw can be safely placed at an angle of 20–33° from the sagittal plane. Overall, measuring the condylar heights (mean [± SD] 10.8 ± 1.5 mm, range 8.1–15.0 mm), widths (mean 11.1 ± 1.4 mm, range 8.5–14.2 mm), lengths (20.3 ± 2.1 mm, range 15.4–24.6 mm), and angles (mean 32.8 ± 5.2°, range 20.2–45.8°) by using CT studies is an accurate and precise method. This finding correlates with the results of prior anatomical studies of occipital condyles and is important in the planning of craniovertebral junction surgery.

Bifid Anterior and Posterior Arches of Atlas

Neurosurgery ◽  
2015 ◽  
Vol 77 (2) ◽  
pp. 296-306 ◽  
Author(s):  
Atul Goel ◽  
Trimurti Nadkarni ◽  
Abhidha Shah ◽  
Raghvendra Ramdasi ◽  
Neeraj Patni
Keyword(s):  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Atlantoaxial Instability ◽  
Os Odontoideum ◽  
Occipital Condyle ◽  
Posterior Arch ◽  
Discrete Movements ◽  
General Observation ◽  
Fixation Techniques ◽  
Group 1

Abstract BACKGROUND: On reviewing the database of patients with craniovertebral junction anomalies, the authors identified 70 patients with a bifid posterior arch of atlas. OBJECTIVE: To speculate on the pathogenesis of spondyloschisis of both the anterior and posterior arches of atlas, particularly as it relates to atlantoaxial instability. METHODS: Seventy patients with bifid anterior and posterior arches were identified by a retrospective review of the database from 2007 to 2013. RESULTS: The ages of the patients ranged from 14 months to 50 years. The patients were divided into 3 groups. Group 1 (3 patients) had multiple additional spinal bony and neural abnormalities. Group 2 (34 patients) had mobile and partially (5) or completely (29) reducible atlantoaxial dislocation. Group 3 (33 patients) had atlantoaxial instability and related basilar invagination. The os odontoideum was identified in 21 patients, and C2-3 fusion was seen in 24 patients. Two of 3 patients in group 1 were treated conservatively and without any surgery. All patients in groups 2 and 3 were surgically treated. Surgery was done using lateral mass plate/rod and screw fixation techniques. The general observation during surgery included identification of discrete movements of both halves of the atlas, lateral positioning of the facets of atlas in relation to the facets of the axis and occipital condyle and closer approximation of the occipital bone, atlas, and axis resulting in “crumpling” of bone and neural elements. CONCLUSION: Understanding of the pathogenesis and mechanical alterations in cases with a bifid arch of atlas can assist in evaluating the clinical implications and in conduct of surgery.

Basilar invagination: craniocervical instability treated with cervical traction and occipitocervical fixation

2007 ◽  
Vol 7 (4) ◽  
pp. 444-449 ◽  
Author(s):  
Ricardo V. Botelho ◽  
Eliseu B. Neto ◽  
Gustavo C. Patriota ◽  
Jefferson W. Daniel ◽  
Paulo A. S. Dumont ◽  
...  
Keyword(s):  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Vertical Position ◽  
Occipitocervical Fixation ◽  
Cervical Traction ◽  
Craniocervical Instability

✓ The upward odontoid displacement observed in basilar invagination (BI) is generally associated with a horizontal clivus and craniocervical kyphosis, conditions that exert ventral compression at the spinomedullary junction. Ventral brainstem decompression by reduction or elimination of the odontoid invagination is part of the desired treatment. The authors describe a case of BI in an adult, who was effectively treated with the easy and safe reduction of odontoid invagination via cervical traction. Normalization of kyphosis at the craniovertebral junction and the vertical position of both a previously horizontal clivus and the cerebellar tentorium demonstrated that these conditions were not part of the original malformation but instead were caused by a reducible craniovertebral instability.

scholarly journals The Feasibility of Anterior Occipital Condyle Screw for the Reconstruction of Craniovertebral Junction: A Digital Anatomical and Cadaveric Study of a Novel Technique

2020 ◽  
Author(s):  
Dingli Xu ◽  
Haijiao Mao ◽  
Yang Wang ◽  
Kaifeng Gan ◽  
Weihu Ma
Keyword(s):  
Sagittal Plane ◽  
Three Dimensional ◽  
Craniovertebral Junction ◽  
Entry Point ◽  
Ct Scans ◽  
Occipital Condyle ◽  
Novel Technique ◽  
Screw Length ◽  
Mesh Cage ◽  
Technique Apply

Abstract Background: Anterior occipital condyle screw (AOCS) could be a feasible technique apply to the reconstruction of craniovertebral junction. This study was to analyze the feasibility of AOCS.Method: The craniovertebral junction computed tomography (CT) scans of 40 adults were enrolled and imported into Mimics software. Then the three-dimensional reconstruction digital model of craniovertebral junction were established to determine entry point, insertion angle and screw’s trajectory. After AOCS inserted into ten human cadaver spine specimens, CT scans were performed to verify the location between screws and important structures. Result: The optimal entry point is located caudally and medial to the ventral of occipital condyle. The optimal trajectory is in inclination angle (5.9°±3.4°) in the sagittal plane and diverge angle (26.7°±6.0°) in the axial plane with the screw length around 21.6±1.2mm. There were no screws invaded into hypoglossal canal and vertebral artery in all specimens.Conclusion: AOCS fixation is a feasible novel technique for anterior craniovertebral junction reconstruction, and it could be an effective alternative operation for anterior reconstruction with titanium mesh cage.

scholarly journals Increase of the clivus-canal angle in patients with basilar invagination, without atlantoaxial displacement, treated with a simple maneuver of indirect decompression of the odontoid with the head clamp, during posterior occipitocervical arthrodesis

2021 ◽  
Vol 12 ◽  
pp. 260
Author(s):  
Claudio Henrique F. Vidal ◽  
Ricardo Brandao Fonseca ◽  
Bruno Leimig ◽  
Walter F. Matias-Filho ◽  
Geraldo Sa Carneiro-Filho
Keyword(s):  
Postoperative Period ◽  
Posterior Approach ◽  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Foramen Magnum ◽  
Occipitocervical Fixation ◽  
Significant Difference ◽  
Indirect Decompression ◽  
Head Clamp

Background: Basilar invagination (BI) can be defined as the insinuation of the content of the craniovertebral junction through the foramen magnum toward the posterior fossa. BI is a prevalent condition in Northeast Brazil. The present study describes the changes in the clivus-canal angle (CCA) in the postoperative period in patients with symptomatic BI operated by a posterior approach, using a simple technique of indirect reduction of the odontoid associated with occipitocervical fixation. Methods: Patients underwent radiological evaluations by magnetic resonance imaging in the pre and postoperative periods, where the height of the odontoid tip was measured in relation to the Chamberlain line and the ACC. All patients underwent posterior occipitocervical fixation with specific maneuvers of distraction and extension of the cephalic segment with the aid of a head clamp with three fixation points for anterior reduction of the odontoid. Results: Among the 8 patients evaluated in the series, all had increased ACC in the postoperative period, with a mean of 14.81 ± 1.54°, and statistically significant difference between the pre and postoperative periods (P < 0.05). Conclusion: The indirect surgical reduction of the odontoid process by a posterior approach through the manipulation (distraction-extension) of a “Mayfield” type of head clamp followed by occipitocervical fixation proved to be effective in improving the ACC, being easily reproducible.

scholarly journals An investigation of craniocervical stability post-condylectomy

2021 ◽  
Vol 12 ◽  
pp. 380
Author(s):  
Brian Fiani ◽  
Ryan Jarrah ◽  
Erika Sarno ◽  
Athanasios Kondilis ◽  
Kory Pasko ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Craniovertebral Junction ◽  
Surgical Approaches ◽  
Occipital Condyle ◽  
Neurosurgical Procedures ◽  
Occipitocervical Fusion ◽  
Surgical Access ◽  
Craniocervical Instability ◽  
Far Lateral ◽  
Occipital Condyles

Background: Occipital condylectomy is often necessary to gain surgical access to various neurological pathologies. As the lateral limit of the craniovertebral junction (CVJ), partial condylectomy can lead to iatrogenic craniocervical instability. What was once considered an inoperable location is now the target of various complex neurosurgical procedures such as tumor resection and aneurysm clipping. Methods: In this study, we will review the anatomical structure of the CVJ and provide the first comprehensive assessment of studies investigating craniovertebral stability following condylectomy with the transcondylar surgical approaches. Furthermore, we discuss future considerations that must be evaluated to optimize the chances of preserving craniocervical stability postcondylectomy. Results: The current findings postulate upward of 75% of the occipital condyle can be resected without significantly affecting mobility of the CVJ. The current findings have only examined overall dimensions and have not established a significant correlation into how the shape of the occipital condyles can affect mobility. Occipitocervical fusion should only be considered after 50% condyle resection. In terms of indicators of anatomical stability, components of range of motion (ROM) such as the neutral zone (NZ) and the elastic zone (EZ) have been discussed as potential measures of craniocervical mobility. These components differ by the sense that the NZ has little ligament tension, whereas the EZ does represent ROM where ligaments experience tension. NZ is a more sensitive indicator of instability when measuring for instability postcondylectomy. Conclusion: Various transcondylar approaches have been developed to access this region including extreme-lateral and far-lateral condylectomy, with hopes of preserving as much of the condyle as possible and maintaining postoperative craniocervical stability.

Basilar Invagination

Neurosurgery ◽  
2010 ◽  
Vol 66 (suppl_3) ◽  
pp. A39-A47 ◽  
Author(s):  
Justin S. Smith ◽  
Christopher I. Shaffrey ◽  
Mark F. Abel ◽  
Arnold H. Menezes
Keyword(s):  
Surgical Treatment ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Foramen Magnum ◽  
Developmental Anomaly ◽  
Autogenous Bone ◽  
Posterior Decompression ◽  
Neural Axis ◽  
Cervical Traction ◽  
Occipital Condyles

Abstract BACKGROUND Basilar invagination is a developmental anomaly of the craniovertebral junction in which the odontoid abnormally prolapses into the foramen magnum. It is often associated with other osseous anomalies of the craniovertebral junction, including atlanto-occipital assimilation, incomplete ring of C1, and hypoplasia of the basiocciput, occipital condyles, and atlas. Basilar invagination is also associated with neural axis abnormalities, including Chiari malformation, syringomyelia, syringobulbia, and hydrocephalus. Patients frequently present with neurologic symptoms and deficits and warrant surgical treatment to prevent progression. OBJECTIVE To review the management of basilar invagination. METHODS The literature was reviewed in reference to the evaluation and management of basilar invagination, with particular emphasis on the surgical treatment. RESULTS Reducible basilar invagination may be treated with posterior decompression and stabilization. Ventral decompression may be necessary for basilar invagination with neural compression that is not reducible with axial cervical traction. Posterior cervical stabilization is necessary after ventral decompression. Modern rod and screw systems combined with autogenous bone graft enable correction of deformity, immediate stabilization, and high fusion rates. CONCLUSION Basilar invagination is a developmental anomaly and commonly presents with neurologic findings. Treatment is typically surgical and involves anterior decompression followed by posterior stabilization for irreducible invagination and posterior decompression and stabilization for reducible invagination.

Endoscopic Transnasal Transclival Odontoidectomy: A New Approach to Decompression: Technical Case Report

2008 ◽  
Vol 63 (suppl_1) ◽  
pp. ONSE92-ONSE94 ◽  
Author(s):  
Jau-Ching Wu ◽  
Wen-Cheng Huang ◽  
Henrich Cheng ◽  
Muh-Lii Liang ◽  
Ching-Yin Ho ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
New Approach ◽  
Prolonged Intubation ◽  
Less Invasive ◽  
Transoral Odontoidectomy ◽  
Occipitocervical Fixation ◽  
Lateral Mass Screws

Abstract Objective: Endoscopic transnasal transclival resection of the odontoid process is less invasive than the standard transoral odontoidectomy. In this article, we describe our techniques, which are less invasive but provide successful decompression. Clinical Presentation: From September 2004 to April 2007, three consecutive patients with basilar invagination and instability in the craniovertebral junction were enrolled. The causes for the invagination and instability included rheumatoid arthritis in two patients and trauma in one patient, and all patients presented with myelopathy and quadriparesis before intervention. Intervention: All three patients underwent an endoscopic transnasal transclival approach for anterior decompression and resection of the displaced odontoid process and pannus to decompress the underlying medulla. Subsequently, they received occipitocervical fixation by lateral mass screws and bone fusion to ensure stability. Remarkable neurological recovery was observed after surgery in all patients, and no adverse effects were noted. Conclusion: Compared with the standard transoral approach, the transnasal transclival endoscopic approach for decompressing basilar invagination is a feasible and effective alternative that avoids common disadvantages like prolonged intubation, excessive tongue retraction, and the need for palatal incision.

Rheumatoid Arthritis of the Craniovertebral Junction

Neurosurgery ◽  
2010 ◽  
Vol 66 (suppl_3) ◽  
pp. A83-A95 ◽  
Author(s):  
William E. Krauss ◽  
Jonathan M. Bledsoe ◽  
Michelle J. Clarke ◽  
Eric W. Nottmeier ◽  
Mark A. Pichelmann
Keyword(s):  
Rheumatoid Arthritis ◽  
Cervical Spine ◽  
Surgical Management ◽  
English Language ◽  
Surgical Navigation ◽  
Surgical Techniques ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Atlantoaxial Instability ◽  
Surgical Methods

Abstract BACKGROUND Rheumatoid arthritis (RA) is the most common inflammatory disease involving the spine. It has a predilection for involving the craniocervical spine. Despite widespread involvement of the cervical spine with RA, few patients need surgery. The 3 major spinal manifestations of RA in the cervical spine are basilar invagination, atlantoaxial instability, and subaxial subluxations. Surgical management of RA involving the craniovertebral junction remains a challenge despite a decline in severe cases and an improvement in surgical techniques. METHODS We conducted an exhaustive review of English-language publications discussing RA involving the craniovertebral junction. We paid special attention to publications detailing modern surgical management of these conditions. In addition, we outline our own surgical experience with such patients. RESULTS We discuss alternative surgical methods for treating basilar invagination, atlantoaxial instability, and concurrent subaxial subluxations. We detail our surgical technique for transoral odontoidectomy, occipital cervical fusion, and atlantoaxial fusion. We detail the use of spinal surgical navigation in both of these procedures. CONCLUSION Surgical management of RA remains a challenging field. There clearly has been a decrease in cases of mutilating RA involving the craniovertebral junction. Surgical techniques for managing these conditions have steadily improved.

Further cranial settling of the upper cervical spine following odontoidectomy

2001 ◽  
Vol 95 (2) ◽  
pp. 246-249 ◽  
Author(s):  
Sait Naderi ◽  
M. Necmettin Pamir
Keyword(s):  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Upper Cervical Spine ◽  
Rigid Fixation ◽  
Content Type ◽  
Fusion Procedure ◽  
Transoral Odontoidectomy ◽  
Occipitocervical Fixation ◽  
Additional Surgery ◽  
Upper Cervical

✓ A variety of diseases may affect the craniovertebral junction and require a decompressive and fusion procedure. Craniovertebral junction instability is expected after a fusion procedure. The authors describe two patients with basilar invagination who underwent transoral odontoidectomy and occipitocervical fixation. Despite an uneventful immediate postoperative course, further cranial settling of the C-2 vertebral body (VB) was demonstrated. One patient experienced neurological deterioration and required a second decompressive procedure, whereas the second patient was asymptomatic and required no additional surgery. It was concluded that the odontoidectomy may have led to horizontal separation of the C-1 lateral masses, resulting in further cranial settling of the C-2 VB. Preservation of one aspect of the C-1 anterior arch minimizes C-1 lateral mass offset and, in turn, further cranial settling of the C-2 VB. In addition, a more rigid fixation of C-2 may minimize the possibility of horizontal separation of the C-1 lateral masses after transoral odontoidectomy.

scholarly journals Morphometry of Occipital condyles: Implications for transcondylar approach to craniovertebral junction lesions

2018 ◽  
Vol 7 (2) ◽  
pp. 1224-1231
Author(s):  
Isaac Cheruiyot ◽  
Phillip Mwachaka ◽  
Hassan Saidi
Keyword(s):  
Craniovertebral Junction ◽  
Occipital Condyle ◽  
Transcondylar Approach ◽  
National Museums ◽  
Study Population ◽  
In Trans ◽  
Males And Females ◽  
The Mean ◽  
Occipital Condyles

Partial occipital condylectomies are commonly done in trans-condylar approach to craniovertebral junction lesions. Following such procedures, post-operative atlanto-occipital joint instability and hypoglossal nerve palsies have been reported and has been attributed to population-specific variations in the occipital condyle (OC) dimensions. Determination of these dimensions may aid in minimizing these complications. One hundred and four (104) OC from 52 skulls (27 males, 25 females) were obtained from the osteology department, National Museums of Kenya. Occipital condyle length (OCL), width (OCW), height (OCH), anterior (AID) and posterior (PID) intercondylar distances and the distance from posterior tip of OC to hypoglossal canal (HC) were obtained using a pair of digital Vernier calipers. The data obtained were entered into SPSS for analysis. The mean OCL, OCW and OCH were 20.59±2.05 mm, 12.23±1.28 mm and 8.65±1.08 mm respectively while AID and PID were 19.66±2.70 mm and 38.52±3.09 mm respectively. Moderate OC type was the most predominant (60.6%). Males and females had predominantly moderate and short OC type respectively (p=0.001). The HC was located 9.62±1.62 mm from the posterior tip of the OC. Males had significantly larger OCL (p<0.001), OCH (p=0.001), PID (p=0.002) and posterior tip of OC to HC distance (p=0.008). Our study population generally has smaller OC dimensions compared to other populations. Females had significantly smaller OCL, OCH, OC-HC distance and PID. Clinicians should therefore take this information into consideration during preoperative planning in craniovertebral junction surgeries among Kenyans and  particularly in females.Key Words: Occipital condyles, Morphometry, Transcondylar approach

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