scholarly journals The anatomical suitability of C1-2 transarticular screw placement in pediatric patients

1999 ◽  
Vol 6 (6) ◽  
pp. E8
Author(s):  
Douglas L. Brockmeyer ◽  
Julie E. York ◽  
Ronald I. Apfelbaum
Keyword(s):  
Pediatric Patients ◽  
Screw Fixation ◽  
Pediatric Population ◽  
Vascular Complications ◽  
Joint Space ◽  
Screw Placement ◽  
Atlantoaxial Instability ◽  
Os Odontoideum ◽  
Transarticular Screw ◽  
Transarticular Screw Fixation

Craniovertebral instability is a challenging problem in pediatric spinal surgery. Recently, C1-2 transarticular screw fixation in pediatric patients has been used to assist in the stabilization of the craniovertebral joint. Currently there are no data that define the anatomical suitability of this technique in the pediatric population. The authors report their experience in 32 pediatric patients in whom craniovertebral instability was treated by placement of C1-2 transarticular screws. From March 1991 to October 1998, 32 patients 16 years of age or younger with atlantooccipital, or atlantoaxial instability, or both were evaluated at our institution. There were 22 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 (nine patients). Six patients had undergone a total of nine previous attempts at posterior fusion at outside institutions. All patients underwent extensive preoperative radiological evaluation including thin cut (1-mm) computerized tomography scanning with multiplanar reconstruction to evaluate the C1-2 joint space anatomy. Of the 64 possible C1-2 joint spaces in 32 patients, 55 sides (86%) were considered suitable for transarticular screw placement preoperatively. In three patients the C1-2 joint space anatomy was considered unsuitable for screw placement bilaterally. In three patients the anatomy was considered inadequate on one side. Fifty-five C1-2 transarticular screws were subsequently placed, with no resulting neurological or vascular complications. We conclude that C1-2 transarticular screw fixation is technically possible in a large proportion of pediatric patients with craniovertebral instability.

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.

Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications, and lessons learned in 67 pediatric patients

2005 ◽  
Vol 2 (2) ◽  
pp. 164-169 ◽  
Author(s):  
Wayne M. Gluf ◽  
Douglas L. Brockmeyer
Keyword(s):  
Pediatric Patients ◽  
Screw Fixation ◽  
Fusion Rate ◽  
Lessons Learned ◽  
Os Odontoideum ◽  
Consecutive Series ◽  
Transarticular Screw ◽  
Content Type ◽  
Transarticular Screw Fixation ◽  
Fine Print

Object. In this, the second of two articles regarding C1–2 transarticular screw fixation, the authors discuss their surgical experience in treating patients 16 years of age and younger, detailing the rate of fusion, complication avoidance, and lessons learned in the pediatric population. Methods. The authors retrospectively reviewed 67 consecutive patients (23 girls and 44 boys) younger than 16 years of age in whom at least one C1–2 transarticular screw fixation procedure was performed. A total of 127 transarticular screws were placed in these 67 patients whose mean age at time of surgery was 9 years (range 1.7–16 years). The indications for surgery were trauma in 24 patients, os odontoideum in 22 patients, and congenital anomaly in 17 patients. Forty-four patients underwent atlantoaxial fusion and 23 patients underwent occipitocervical fusion. Two of the 67 patients underwent halo therapy postoperatively. All patients were followed for a minimum of 3 months. In all 67 patients successful fusion was achieved.Complications occurred in seven patients (10.4%), including two vertebral artery injuries. Conclusions. The use of C1–2 transarticular screw fixation, combined with appropriate atlantoaxial and craniovertebral bone/graft constructs, resulted in a 100% fusion rate in a large consecutive series of pediatric patients. The risks of C1–2 transarticular screw fixation can be minimized in this population by undertaking careful patient selection and meticulous preoperative planning.

The anatomical suitability of the C1–2 complex for transarticular screw fixation

1996 ◽  
Vol 85 (2) ◽  
pp. 221-224 ◽  
Author(s):  
Christopher G. Paramore ◽  
Curtis A. Dickman ◽  
Volker K. H. Sonntag
Keyword(s):  
Screw Fixation ◽  
Ct Scans ◽  
Screw Placement ◽  
Consecutive Series ◽  
Transarticular Screw ◽  
Transverse Foramen ◽  
Content Type ◽  
Transarticular Screw Fixation ◽  
The Right ◽  
Fine Print

✓ Posterior transarticular screw fixation of the C1–2 complex has become an accepted method of rigid internal fixation for patients requiring posterior C1–2 fusion. The principal limitation of this procedure is the location of the vertebral artery, because an anomalous position may prohibit screw placement. In this study, a consecutive series of computerized tomography (CT) scans was reviewed, and the suitability of each patient for transarticular screw fixation was evaluated. All of the fine-slice axial C1–2 CT scans and reconstructions performed on a spiral scanner over 2 years were reviewed. A novel screw trajectory reconstruction was designed to visualize the potential path of a transarticular screw in the plane of the reconstruction. Scans were reviewed for bone anatomy and the position of the transverse foramen. Seventeen (18%) of 94 patients had a high-riding transverse foramen on at least one side of the C-2 vertebra that would prohibit the placement of transarticular screws. The left side was involved in nine patients and the right in five. Three patients had bilateral anomalies. The mean age of the group with anomalies (35.9 years, range 10–76) was not significantly different from the overall mean age (35.7 years, range 6–94). An additional five patients (5%) were considered to have anatomy in which screw placement was feasible but risky. On the basis of these data, it is postulated that 18% to 23% of patients may not be suitable candidates for posterior C1–2 transarticular screw fixation on at least one side.

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