Atlantal lateral mass screws for posterior spinal reconstruction

2002 ◽  
Vol 12 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Amory J. Fiore ◽  
Regis W. Haid ◽  
Gerald E. Rodts ◽  
Brian R. Subach ◽  
Praveen V. Mummaneni ◽  
...  
Keyword(s):  
Atlantoaxial Subluxation ◽  
Rigid Fixation ◽  
Lateral Mass ◽  
Occipitocervical Fixation ◽  
Spinal Reconstruction ◽  
Alternative Method ◽  
Upper Cervical ◽  
Atlantoaxial Fixation ◽  
Lateral Mass Screws ◽  
Additional Fixation

Object A variety of techniques may be used to achieve fixation of the upper cervical spine. Transarticular atlantoaxial screws, posterior interspinous cable and graft constructs, and interlaminar clamps have been used effectively to achieve atlantoaxial fixation. Various anatomical factors, however, may preclude the successful application of these techniques. These factors include aberrant vertebral artery anatomy, irreducible atlantoaxial subluxation, exaggerated cervicothoracic kyphosis, and the absence of the osseous substrate for fixation. In these cases, an alternative method of fixation must be performed. The authors present an alternative method to achieve fixation of the atlas in which lateral mass screws can be applied to atlantoaxial and occipitocervical fixation. Methods Between February 1998 and November 2001, eight patients who ranged in age from 16 to 74 years underwent posterior fixation for upper cervical instability. Diagnoses included C-2 metastastic disease in two patients, irreducible odontoid fractures in two patients, atlantoaxial subluxation in two patients, and transverse ligament synovial cyst in two patients. Various anatomical factors precluded transarticular atlantoaxial screw fixation in seven patients. One patient with a highly unstable spine due to a C-2 metastasis and pathological fracture underwent occipitocervical fusion. Atlantocervical fixation was achieved in seven patients by using varying constructs incorporating C-1 lateral mass screws. Occipitocervical fixation was achieved in one patient by incorporating C-1 lateral mass screws as an additional fixation point. A total of 14 C-1 lateral mass screws were placed in eight patients. There were no intraoperative complications. In all patients rigid fixation was achieved as demonstrated on postoperative radiographs. One patient died on postoperative Day 9 of aspiration pneumonia. At a mean follow-up time of 7.4 months, rigid fixation was maintained in all patients. Conclusions Atlantal lateral mass screws can be used to provide a safe and efficacious means of achieving atlantoaxial fixation when anatomical constraints preclude the use of a more traditional procedure. Atlantal lateral mass screws may also be incorporated in occipitocervical constructs to provide additional fixation points which may prevent construct failure.

scholarly journals C1 lateral mass screws for posterior segmental stabilization of the upper cervical spine and a new method of three-point rigid fixation of the C1-C2 complex

2006 ◽  
Vol 64 (3b) ◽  
pp. 762-767 ◽  
Author(s):  
Marcelo D. Vilela ◽  
Charles Jermani ◽  
Bruno P. Braga
Keyword(s):  
Cervical Spine ◽  
New Method ◽  
Fixation Method ◽  
Upper Cervical Spine ◽  
Rigid Fixation ◽  
Lateral Mass ◽  
Upper Cervical ◽  
Lateral Mass Screws ◽  
Stable Fusion

OBJECTIVE: To describe our experience with C1 lateral mass screws as part of a construct for C1-2 stabilization and report an alternate method of C1-C2 complex three-point fixation. METHOD: All patients that had at least one screw placed in the lateral mass of C1 as part of a construct for stabilization of the C1-C2 complex entered this study. In selected patients who had a higher chance of nonunion an alternate construct was used: transarticular C1-C2 screws combined with C1 lateral mass screws. RESULTS: Twenty-one C1 lateral mass screws were placed in 11 patients. In three patients the alternate construct was used. All patients had a demonstrable solid and stable fusion on follow-up. CONCLUSION: C1 lateral mass screws are safe and provide immediate stability. The use of C1-C2 transarticular screws combined with C1 lateral mass screws is a feasible and also an excellent alternative for a three-point fixation of the C1-C2 complex.

Screw fixation of the upper cervical spine in the pediatric population

2009 ◽  
Vol 3 (6) ◽  
pp. 529-533 ◽  
Author(s):  
Atif Haque ◽  
Angela V. Price ◽  
Frederick H. Sklar ◽  
Dale M. Swift ◽  
Bradley E. Weprin ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Screw Fixation ◽  
Pediatric Population ◽  
Ct Scanning ◽  
Upper Cervical Spine ◽  
Rigid Fixation ◽  
Lateral Mass ◽  
Upper Cervical ◽  
Lateral Mass Screws ◽  
Attending Physician

Object Rigid fixation of the upper cervical spine has become an established method of durable stabilization for a variety of craniocervical pathological entities in children. In children, specifically, the use of C1–2 transarticular screws has been proposed in recent literature to be the gold standard configuration for pathology involving these levels. The authors reviewed the use of rigid fixation techniques alternative to C1–2 transarticular screws in children. Factors evaluated included ease of placement, complications, and postoperative stability. Methods Seventeen patients, ranging in age from 3 to 17 years (mean 9.6 years), underwent screw fixation involving the atlas or axis for a multitude of pathologies, including os odontoideum, Down syndrome, congenital instability, iatrogenic instability, or posttraumatic instability. All patients had preoperative instability of the occipitocervical or atlantoaxial spine demonstrated on dynamic lateral cervical spine radiographs. All patients also underwent preoperative CT scanning and MR imaging to evaluate the anatomical feasibility of the selected hardware placement. Thirteen patients underwent C1–2 fusion, and 4 underwent occipitocervical fusion, all incorporating C-1 lateral mass screws, C-2 pars screws, and/or C-2 laminar screws within their constructs. Patients who underwent occipitocervical fusion had no instrumentation placed at C-1. One patient's construct included sublaminar wiring at C-2. All patients received autograft onlay either from from rib (in 15 patients), split-thickness skull (1 patient), or local bone harvested within the operative field (1 patient). Nine patients' constructs were supplemented with recombinant human bone morphogenetic protein at the discretion of the attending physician. Eight patients had surgical sacrifice of 1 or both C-2 nerve roots to better facilitate visualization of the C-1 lateral mass. One patient was placed in halo-vest orthosis postoperatively, while the rest were maintained in rigid collars. Results All 17 patients underwent immediate postoperative CT scanning to evaluate hardware placement. Follow-up was achieved in 16 cases, ranging from 2 to 39 months (mean 14 months), and repeated dynamic lateral cervical spine radiography was performed in these patients at the end of their follow-up period. Some, but not all patients, also underwent delayed postoperative CT scans, which were done at the discretion of the treating attending physician. No neurovascular injuries were encountered, no hardware revisions were required, and no infections were seen. No postoperative pain was seen in patients who underwent C-2 nerve root sacrifice. Stability was achieved in all patients postoperatively. In all patients who underwent delayed postoperative CT scanning, the presence of bridging bone was shown spanning the fused levels. Conclusions Screw fixation of the atlas using lateral mass screws, in conjunction with C-2 root sacrifice in selected cases, and of the axis using pars or laminar screws is a safe method for achieving rigid fixation of the upper cervical spine in the pediatric population.

scholarly journals The use of intraoperative navigation for complex upper cervical spine surgery

2014 ◽  
Vol 36 (3) ◽  
pp. E5 ◽  
Author(s):  
Kern H. Guppy ◽  
Indro Chakrabarti ◽  
Amit Banerjee
Keyword(s):  
Cervical Spine ◽  
Navigation System ◽  
Surgical Navigation ◽  
Spinal Instrumentation ◽  
Pedicle Screws ◽  
Upper Cervical Spine ◽  
Cervical Canal ◽  
Lateral Mass ◽  
Upper Cervical ◽  
Lateral Mass Screws

Imaging guidance using intraoperative CT (O-arm surgical imaging system) combined with a navigation system has been shown to increase accuracy in the placement of spinal instrumentation. The authors describe 4 complex upper cervical spine cases in which the O-arm combined with the StealthStation surgical navigation system was used to accurately place occipital screws, C-1 screws anteriorly and posteriorly, C-2 lateral mass screws, and pedicle screws in C-6. This combination was also used to navigate through complex bony anatomy altered by tumor growth and bony overgrowth. The 4 cases presented are: 1) a developmental deformity case in which the C-1 lateral mass was in the center of the cervical canal causing cord compression; 2) a case of odontoid compression of the spinal cord requiring an odontoidectomy in a patient with cerebral palsy; 3) a case of an en bloc resection of a C2–3 chordoma with instrumentation from the occiput to C-6 and placement of C-1 lateral mass screws anteriorly and posteriorly; and 4) a case of repeat surgery for a non-union at C1–2 with distortion of the anatomy and overgrowth of the bony structure at C-2.

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.

Atlantoaxial Fixation using C2 Subarticular Screws and C1 Lateral Mass Screws: A Technical Report

2006 ◽  
Vol 41 (6) ◽  
pp. 1061
Author(s):  
Jong Hwa Won ◽  
Jin Sup Yeom ◽  
Hak Jin Min ◽  
Ui Seong Yoon ◽  
Bong Soon Chang ◽  
...  
Keyword(s):  
Lateral Mass ◽  
Technical Report ◽  
Atlantoaxial Fixation ◽  
Lateral Mass Screws

Biomechanical comparison of two new atlantoaxial fixation techniques with C1–2 transarticular screw–graft fixation

2006 ◽  
Vol 5 (4) ◽  
pp. 336-342 ◽  
Author(s):  
Roger Härtl ◽  
Robert H. Chamberlain ◽  
Mary S. Fifield ◽  
Dean Chou ◽  
Volker K. H. Sonntag ◽  
...  
Keyword(s):  
Gold Standard ◽  
Screw Fixation ◽  
Axial Rotation ◽  
Lateral Mass ◽  
Lateral Bending ◽  
Transarticular Screw ◽  
New Techniques ◽  
Transarticular Screw Fixation ◽  
Atlantoaxial Fixation ◽  
Lateral Mass Screws

Object Two new techniques for atlantoaxial fixation have been recently described. In one technique, C-2 intra-laminar screws are connected with C-1 lateral mass screws; in the second, C-1 and C-3 lateral mass screws are interconnected and C-2 is wired sublaminarly. Both techniques include a C1–2 interspinous graft. The authors compared these techniques with the gold-standard, interspinous graft–augmented C1–2 transarticular screw fixation and with a control C1–2 interspinous graft fixation procedure alone. Methods In six human cadaveric occiput–C4 specimens, nonconstraining 1.5-Nm pure moments were applied to induce flexion, extension, lateral bending, and axial rotation during which three-dimensional angular motion was measured optoelectronically. Each specimen was tested in the normal state, with graft alone (after odontoidectomy), and then in varying order after applying each construct with a rewired graft. All three constructs allowed significantly less angular motion at the C1–2 junction than the wired interspinous graft alone during lateral bending and axial rotation (p < 0.01, paired Student t-test) but not during flexion or extension. Transarticular screw fixation with an interspinous graft allowed less motion at the atlantoaxial junction than the two new constructs in several conditions. Differences were greater between the transarticular screw construct and the intralaminar screw construct than between the transarticular screw construct and the C1–3 lateral mass screw construct. During lateral bending and axial rotation, the C1–3 construct allowed less motion at the atlantoaxial junction than the intralaminar screw construct. Conclusions Biomechanically, the gold-standard C1–2 transarticular screw fixation outperformed the two new techniques during lateral bending and axial rotation. Wiring C-2 to C1–3 rods provided greater stability than C1–2 laminar screws, but it sacrificed C2–3 mobility. It is unknown whether the small differences observed biomechanically would lead to clinically relevant differences in fusion rates.

Cervical Posterior Fusion Rods Undergo Substantial Bending Deformations for Activities of Daily Living

2009 ◽  
Author(s):  
J. P. Rodriguez ◽  
J. Scheer ◽  
J. Eguizabal ◽  
J. M. Buckley ◽  
T. McClellan ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Daily Living ◽  
Small Diameter ◽  
Rigid Fixation ◽  
Lateral Mass ◽  
Spinal Cord Tumors ◽  
Fixation Technique ◽  
Spinal Ligaments ◽  
Lateral Mass Screws

Cervical corpectomy is a procedure most commonly indicated for resection of metastatic disease in the vertebra, access to the spinal cord tumors and inflammatory or infectious lesions.[1] Posterior occipitocervical instrumentation with rods and lateral mass screws has been shown to be a rigid fixation technique in this region [2] and, small diameter rods are thought to be lighter weight, less prominent and less likely to be associated with screw pullout.[3] Still, deformity imposed upon small diameter rods, by the weight of the head, the cervical spine, and spinal ligaments has yet to be quantified. Anecdotal observations show that the rods lose their lordotic curvature and patients fuse in a kyphotic curve making daily living more difficult. The goal of this study is to examine the mechanical behavior of these rods in situ under physiologic loading conditions reflective of activies of daily living.

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