Rigid occipitocervical fusion

1999 ◽  
Vol 91 (2) ◽  
pp. 144-150 ◽  
Author(s):  
Fernando L. Vale ◽  
Mark Oliver ◽  
David W. Cahill
Keyword(s):  
Screw Fixation ◽  
Craniocervical Junction ◽  
Senior Author ◽  
Rigid Fixation ◽  
Rotational Deformity ◽  
Occipitocervical Fusion ◽  
Content Type ◽  
Occipitocervical Fixation ◽  
Fixation System ◽  
Fine Print

Object. Despite 50 years of neurosurgical experience, occipitocervical fusion continues to present a technical challenge to the surgeon. Traditional nonrigid techniques applied in the occiput and cervical spine often fail secondary to postsurgical cranial settling or rotational deformity. Unlike widely used nonrigid and semirigid techniques, rigid fixation of the craniocervical junction should allow correction of deformity in any plane, provide immediate stability without need for external orthosis, and prevent cranial settling. Methods. Since 1992, the senior author (D.W.C.) has used a rigid plate and screw fixation system for occipitocervical fusions. The technique proved to be more difficult than expected, and the procedure has evolved as experience was gained. The authors present a series of 24 patients and a technique that now involves the use of a custom-designed T-plate that is attached to the midline occipital “keel” at one end and to the spine at the other end by means of screw-fixed plates. Conclusions. Although it is still evolving, the current technique for obtaining rigid occipitocervical fixation allows for immediate rigidity and stability of the spine without the use of an external orthosis (that is, in the absence of osteoporosis), may be extended to any level of the spine, may be used in the absence of posterior elements, prevents postsurgical cranial settling and restenosis, facilitates reduction of the spinal deformity in any plane, and sometimes eliminates the need for an anterior (transoral) decompressive procedure.

Translaminar rigid screw fixation of the axis

2005 ◽  
Vol 3 (5) ◽  
pp. 409-414 ◽  
Author(s):  
Neill M. Wright
Keyword(s):  
At Risk ◽  
Vertebral Artery ◽  
Screw Fixation ◽  
Vascular Complications ◽  
Pedicle Screws ◽  
Rigid Fixation ◽  
Content Type ◽  
Risk Of Injury ◽  
Translaminar Screws ◽  
Fine Print

✓ Rigid fixation of the axis with C1–2 transarticular screws or C-2 pedicle screws results in high fusion rates but remains technically demanding because of the risk of injury to the vertebral artery (VA) and the limitations imposed by anatomical variability. Translaminar fixation of the axis with crossing bilateral screws provides rigid fixation and is technically simple, is not affected by variations in individual anatomy, and does not place the VA at risk. The longterm results in 20 patients treated with translaminar fixation for craniocervical, atlantoaxial, and axial—subaxial instability are presented, with 100% fusion rates and no neurological or vascular complications. Translaminar screws may be a good option for rigid fixation of the axis for surgeons not proficient in the more technically demanding methods of stabilization.

Hook—rod with pedicle screw fixation for unstable spinal fracture

2000 ◽  
Vol 92 (1) ◽  
pp. 117-121
Author(s):  
Marin F. Stančić ◽  
Vladimir Mićcović ◽  
Mark Potočnjak
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Spinal Fracture ◽  
Pedicle Screw Fixation ◽  
Neurological Deficits ◽  
Content Type ◽  
Fixation System ◽  
Fine Print

U A technique is described in which spinal fracture repositioning, decompression, and stabilization are achieved by a combination of hook—rod and pedicle screw fixation. This straightforward technique is useful for performing acute decompression in patients with partial neurological deficits and multisystem injuries. A laminectomy allows for placement of a stiffer fixation system, and it improves the insufficient canal clearance obtained when performing annulotaxis alone.

Posterior atlantoaxial facet screw fixation in rheumatoid arthritis

1998 ◽  
Vol 89 (1) ◽  
pp. 8-12 ◽  
Author(s):  
Mohammed Aly Eleraky ◽  
Roberto Masferrer ◽  
Volker K. H. Sonntag
Keyword(s):  
Screw Fixation ◽  
Class Ii ◽  
Atlantoaxial Instability ◽  
Rigid Fixation ◽  
Class Iii ◽  
Transarticular Screw ◽  
Content Type ◽  
Transarticular Screw Fixation ◽  
Fine Print

Object. This retrospective review was conducted to determine the efficacy of transarticular screw fixation in a group of patients who were treated for rheumatoid atlantoaxial instability. Methods. Thirty-six patients (mean age 63 years) with rheumatoid atlantoaxial instability were treated with posterior atlantoaxial transarticular screw fixation supplemented with an interspinous C1–2 strut graft—cable construct to provide immediate three-point fixation to facilitate bone fusion. Previous attempts at fusions by using bone grafting with wire fixation at other institutions had failed in six of these patients. Six patients underwent transoral odontoid resections for removal of large irreducible pannus as a first-stage procedure, which was followed within 2 to 3 days by the posterior procedure. Postoperatively, 33 patients were placed in hard cervical collars and three required halo vests because of severe osteoporosis. Of eight patients categorized as Ranawat Class II preoperatively, all eight returned to normal after surgery; of eight patients in Ranawat Class III-A preoperatively, four improved to Class II and four remained unchanged. All 20 patients classified as Ranawat Class I preoperatively recovered completely. Pain decreased or resolved in all patients, and there were no complications related to instrumentation. At follow-up review (mean 2 years), 33 patients (92%) had solid bone fusions, and three (8%) had stable fibrous unions. Conclusions. Posterior atlantoaxial transarticular screw fixation provides a good surgical alternative for the management of patients with rheumatoid atlantoaxial instability. This technique provides immediate three-point rigid fixation of the C1–2 region, thus obviating the need for halo vest immobilization in most cases.

Rigid occipitocervical fusion

1999 ◽  
Vol 6 (6) ◽  
pp. E10 ◽  
Author(s):  
Fernando L. Vale ◽  
Mark Oliver ◽  
David W. Cahill
Keyword(s):  
Operative Procedure ◽  
Fusion Rate ◽  
Craniocervical Junction ◽  
Senior Author ◽  
Rigid Fixation ◽  
Spinal Fixation ◽  
Occipitocervical Fusion ◽  
Complex Anatomy ◽  
Craniocervical Instability ◽  
Spine Surgeon

For more than 50 years occipitocervical fusion has been performed for the management of craniocervical instability. Despite advances in technology, craniocervical fixation continues to be a technical challenge to the spine surgeon. The complex anatomy of the region and the frequent need for anterior and/or posterior decompressive procedures represent a mechanical disadvantage and are associated with a high failure rate. Numerous methods for spinal fixation have been developed, but none has gained widespread popularity. The use of plates and screws to obtain rigid fixation of the craniocervical junction is desirable because it allows correction of deformity, provides immediate stability, and precludes cranial settling. The technique is demanding and sometimes fraught with complications. Since 1992, the senior author (D.W.C.) has used a rigid plating technique to treat patients with craniocervical instability. This procedure proved more difficult than expected, and the operative procedure has evolved as experience has been gained. The authors present a series of 24 patients and describe a technique that, in their experience, decreased the complication rate and improved the fusion rate. The technique involves a custom-designed "T-plate" that is attached to the midline occipital bone and to the cervical spine with lateral mass plates.

A biomechanical evaluation of occipitocervical instrumentation: screw compared with wire fixation

1999 ◽  
Vol 90 (1) ◽  
pp. 84-90 ◽  
Author(s):  
R. John Hurlbert ◽  
Neil R. Crawford ◽  
Won Gyu Choi ◽  
Curtis A. Dickman
Keyword(s):  
Optical Sensors ◽  
Screw Fixation ◽  
Angular Displacement ◽  
Linear Displacement ◽  
Transarticular Screw ◽  
Content Type ◽  
Fusion Construct ◽  
Occipitocervical Fixation ◽  
Flexion Extension ◽  
Fine Print

Object. The purpose of this study was to compare cable techniques used in occipitocervical fixation with two types of screw fixation. The authors hypothesized that screw fixation would provide superior immobilization compared with cable methods. Methods. Ten cadaveric specimens were prepared for biomechanical analyses by using standard techniques. Angular and linear displacement data were recorded from the occiput to C-6 with infrared optical sensors after conditioning runs. Specimens underwent retesting after fatiguing. Six methods of fixation were analyzed: Steinmann pin with and without C-1 incorporation; Cotrel-Dubousett horseshoe with and without C-1 incorporation; Mayfield loop with C1–2 transarticular screw fixation; and a custom-designed occipitocervical transarticular screw-plate system. Sublaminar techniques were extended to include C-3 in the fusion construct, whereas transarticular techniques incorporated the occiput, C-1, and C-2 only. All methods of fixation provided significant immobilization in all specimens compared with the nonconstrained destabilized state. Despite incorporation of an additional vertebral segment, sublaminar techniques performed worse as a function of applied load than screw fixation techniques. Following fatiguing, these differences were more pronounced. The sublaminar techniques failed most prominently in flexion—extension and in axial rotation. On gross inspection, increased angular displacement associated with loosening of the sublaminar cables was observed. Conclusion. Occipitocervical fixation can be performed using a variety of techniques; all bestow significant immobilization compared with the destabilized spine. All methods tested in this study were susceptible to fatigue and loss of reduction and were weakest in resisting vertical settling. Screw fixation of the occiput—C2 reduces the number of vertebral segments that are necessary to incorporate into the fusion construct while providing superior immobilization and resistance to fatigue and vertical settling compared with sublaminar methods.

Posterior atlantoaxial facet screw fixation

1993 ◽  
Vol 79 (2) ◽  
pp. 234-237 ◽  
Author(s):  
Paul Marcotte ◽  
Curtis A. Dickman ◽  
Volker K. H. Sonntag ◽  
Dean G. Karahalios ◽  
Janine Drabier
Keyword(s):  
Screw Fixation ◽  
Metastatic Tumor ◽  
Atlantoaxial Instability ◽  
Os Odontoideum ◽  
Rigid Fixation ◽  
Spinal Fixation ◽  
Strut Graft ◽  
Content Type ◽  
Fine Print

✓ Eighteen patients with atlantoaxial instability were treated with posterior atlantoaxial facet screws to obtain immediate rigid fixation of C1–2. Of these 18 patients, instability occurred due to trauma in nine, rheumatoid arthritis in six, neoplasms in two, and os odontoideum in one. Four patients presented with nonunion after failed C1–2 wire and graft procedures. In all cases in this series the screw fixations were augmented with an interspinous C1–2 strut graft which was wired in place to provide three-point stabilization and to facilitate bone fusion. In every case fixation was satisfactory, and C1–2 alignment and stability were restored without complications due to instrumentation. One patient died 3 months postoperatively from metastatic tumor; the spinal fixation was intact. All 17 surviving patients have developed osseous unions (mean follow-up period 12 months, range 6 to 16 months). Posterior atlantoaxial facet screw fixation provides immediate multidirectional rigid fixation of C1–2 that is mechanically superior to wiring or clamp fixation. This technique maximizes success without the need for a supplemental rigid external orthosis, and is particularly useful for pseudoarthrosis.

Circumferential fracture of the skull base causing craniocervical dislocation

2002 ◽  
Vol 97 (1) ◽  
pp. 118-122 ◽  
Author(s):  
Ganesh Rao ◽  
Adam S. Arthur ◽  
Ronald I. Apfelbaum
Keyword(s):  
High Speed ◽  
Unusual Case ◽  
Motor Vehicle ◽  
Neurological Impairment ◽  
Craniocervical Junction ◽  
Motor Vehicle Accidents ◽  
Review Of The Literature ◽  
Content Type ◽  
Vehicle Accidents ◽  
Fine Print

✓ Fractures of the craniocervical junction are common in victims of high-speed motor vehicle accidents; indeed, injury to this area is often fatal. The authors present the unusual case of a young woman who sustained a circumferential fracture of the craniocervical junction. Despite significant trauma to this area, she suffered remarkably minor neurological impairment and made an excellent recovery. Her injuries, treatment, and outcome, as well as a review of the literature with regard to injuries at the craniocervical junction, are discussed.

Bilateral open-door cervical expansive laminoplasty with hydroxyapatite spacers and titanium screws

2002 ◽  
Vol 96 (1) ◽  
pp. 22-28 ◽  
Author(s):  
Masakazu Takayasu ◽  
Teruhide Takagi ◽  
Toshihisa Nishizawa ◽  
Koji Osuka ◽  
Takehiko Nakajima ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Cervical Spinal Cord ◽  
Intraoperative Complications ◽  
Fixation Strength ◽  
Open Door ◽  
Quick Method ◽  
Simple Method ◽  
Content Type ◽  
Titanium Screws ◽  
Fine Print

Object. The authors report a simple method for bilateral open-door cervical expansive laminoplasty in which hydroxyapatite (HA) spacers are secured by titanium screws. A biomechanical study was also conducted to confirm the strength of the screw fixation. Methods. A unilateral posterior approach was used to allow preservation of the posterior supporting elements (the posterior tension band) until the laminae were cut at the base. A bilateral open-door expansive laminotomy was then performed in standard fashion. Appropriate-sized HA spacers were selected, held with a specially designed holder, and placed between the split laminae. The screw holes were made in the laminae along the direction of the screw holes in the spacer, and two screws were inserted ventrolaterally to the laminae, resulting in instantaneous fixation. This procedure was performed in 15 patients; clinical results were successful, and there were no significant intraoperative complications. Follow-up radiological studies revealed no evidence of displacement of the spacers or screw backout. The screw artifacts observed on magnetic resonance imaging were minimal, allowing evaluation of the cervical spinal cord. The sagittal alignment of the cervical spine was well preserved. In the biomechanical studies the authors found that the screw fixation was of satisfactory strength, compared with other methods of fixation. Conclusions. Bilateral open-door cervical expansive laminoplasty in which HA spacers are secured by titanium screws is a simple and quick method that yields sufficient fixation strength.

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.

Application of frameless stereotaxy to pedicle screw fixation of the spine

1995 ◽  
Vol 83 (4) ◽  
pp. 641-647 ◽  
Author(s):  
Iain H. Kalfas ◽  
Donald W. Kormos ◽  
Michael A. Murphy ◽  
Rick L. McKenzie ◽  
Gene H. Barnett ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Spinal Surgery ◽  
Screw Fixation ◽  
Ct Images ◽  
Pedicle Screw Fixation ◽  
Lumbosacral Spine ◽  
Frameless Stereotaxy ◽  
Content Type ◽  
Screw Length ◽  
Fine Print

✓ Interactive frameless stereotaxy has been successfully applied to intracranial surgery. It has contributed to the improved localization of deep-seated brain lesions and has demonstrated a potential for reducing both operative time and morbidity. However, it has not been as effectively applied to spinal surgery. The authors describe the application of frameless stereotactic techniques to spinal surgery, specifically pedicle screw fixation of the lumbosacral spine. Preoperative axial computerized tomography (CT) images of the appropriate spinal segments are obtained and loaded onto a high-speed graphics supercomputer workstation. Intraoperatively, these images can be linked to the appropriate spinal anatomy by a sonic localization digitizer device that is interfaced with the computer workstation. This permits the surgeon to place a pointing device (sonic wand) on any exposed spinal bone landmark in the operative field and obtain multiplanar reconstructed CT images projected in near-real time on the workstation screen. The images can be manipulated to assist the surgeon in determining the proper entry point for a pedicle screw as well as defining the appropriate trajectory in the axial and sagittal planes. It can also define the correct screw length and diameter for each pedicle to be instrumented. The authors applied this device to the insertion of 150 screws into the lumbosacral spines of 30 patients. One hundred forty-nine screws were assessed to be satisfactorily placed by postoperative CT and plain film radiography. In this report the authors discuss their use of this device in the clinical setting and review their preliminary results of frameless stereotaxy applied to spinal surgery. On the basis of their findings, the authors conclude that frameless stereotactic technology can be successfully applied to spinal surgery.

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