Fusion and instrumentation at C1–3 via the high anterior cervical approach

2000 ◽  
Vol 92 (1) ◽  
pp. 24-29 ◽  
Author(s):  
John R. Vender ◽  
Steven J. Harrison ◽  
Dennis E. McDonnell
Keyword(s):  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Upper Cervical Spine ◽  
Content Type ◽  
Upper Cervical ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Solid Fusion ◽  
Posterior Procedure ◽  
Fine Print

Object. The high anterior cervical, retropharyngeal approach to the anterior foramen magnum and upper cervical spine is a favorable alternative to the transoral and posterolateral approaches, which both cause instability of the craniovertebral junction. Previously, such instability was corrected via an occipitocervical fusion during a separate surgical procedure. Methods. Seven patients requiring C-2 corpectomy (foramen magnum meningioma [two patients], critical stenosis secondary to rheumatoid arthritis [two patients], C-2 fracture [two patients], and stenosis secondary to Rickets [one patient]) are presented. All patients underwent C1–3 fusion followed by instrumentation with a Caspar plate. A solid fusion was achieved in six patients. One patient experienced erosion of the anterior arch of C-1 requiring posterior stabilization. Conclusions. Fusion and instrumentation at C1–3 can be performed safely and with minimal increase in surgical time. In selected patients, this may eliminate the need for an additional posterior procedure and maintain occipital—C1 mobility.

Stability of the craniovertebral junction after unilateral occipital condyle resection: a biomechanical study

1999 ◽  
Vol 90 (1) ◽  
pp. 91-98 ◽  
Author(s):  
A. Giancarlo Vishteh ◽  
Neil R. Crawford ◽  
M. Stephen Melton ◽  
Robert F. Spetzler ◽  
Volker K. H. Sonntag ◽  
...  
Keyword(s):  
Axial Rotation ◽  
Craniovertebral Junction ◽  
Biomechanical Study ◽  
Occipital Condyle ◽  
Upper Cervical Spine ◽  
Lateral Bending ◽  
Content Type ◽  
Axial Translation ◽  
Flexion Extension ◽  
Fine Print

Object. The authors sought to determine the biomechanics of the occipitoatlantal (occiput [Oc]—C1) and atlantoaxial (C1–2) motion segments after unilateral gradient condylectomy. Methods. Six human cadaveric specimens (skull with attached upper cervical spine) underwent nondestructive biomechanical testing (physiological loads) during flexion—extension, lateral bending, and axial rotation. Axial translation from tension to compression was also studied across Oc—C2. Each specimen served as its own control and underwent baseline testing in the intact state. The specimens were then tested after progressive unilateral condylectomy (25% resection until completion), which was performed using frameless stereotactic guidance. At Oc—C1 for all motions that were tested, mobility increased significantly compared to baseline after a 50% condylectomy. Flexion—extension, lateral bending, and axial rotation increased 15.3%, 40.8%, and 28.1%, respectively. At C1–2, hypermobility during flexion—extension occurred after a 25% condylectomy, during axial rotation after 75% condylectomy, and during lateral bending after a 100% condylectomy. Conclusions. Resection of 50% or more of the occipital condyle produces statistically significant hypermobility at Oc—C1. After a 75% resection, the biomechanics of the Oc—C1 and C1–2 motion segments change considerably. Performing fusion of the craniovertebral junction should therefore be considered if half or more of one occipital condyle is resected.

Fractures of the C-2 vertebral body

1994 ◽  
Vol 81 (2) ◽  
pp. 206-212 ◽  
Author(s):  
Edward C. Benzel ◽  
Blaine L. Hart ◽  
Perry A. Ball ◽  
Nevan G. Baldwin ◽  
William W. Orrison ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Soft Tissue ◽  
Mr Imaging ◽  
Upper Cervical Spine ◽  
Content Type ◽  
Body Fracture ◽  
Pars Interarticularis ◽  
Upper Cervical ◽  
Type 3 ◽  
Fine Print

✓ Vertical C-2 body fractures are presented in 15 patients with clinical and imaging correlations that suggest the existence of a variety of mechanisms of injury. In these patients, clinical and imaging correlations were derived by: 1) defining the point of impact by clinical examination; 2) defining the point of impact by soft-tissue changes on cranial magnetic resonance (MR) imaging or computerized tomography (CT); 3) obtaining an accurate history of the mechanism of injury; and 4) spine imaging (x-ray studies, CT, and MR imaging) of the C-2 body fracture and surrounding bone and soft tissue. The cases presented involve the region located between the dens and the pars interarticularis of the axis. Although these fractures are rarely reported, they are not uncommon. An elucidation of their pathological anatomy helps to further the understanding of the mechanistic etiology of upper cervical spine trauma. A spectrum of mechanisms of injury causing upper cervical spine fractures was observed. The type of injury incurred is determined predominantly by the force vector applied during impact and the intrinsic strength and anatomy of C-2 and its surrounding spinal elements. From this clinical experience, two types of vertical C-2 body fractures are defined and presented: coronally oriented (Type 1) and sagittally oriented (Type 2). A third type of C-2 body fracture, the horizontal rostral C-2 fracture (Type 3), is added for completeness; this Type 3 fracture is the previously described Type III odontoid process fracture described by Anderson and D'Alonzo.

Treatment of basilar invagination by atlantoaxial joint distraction and direct lateral mass fixation

2004 ◽  
Vol 1 (3) ◽  
pp. 281-286 ◽  
Author(s):  
Atul Goel
Keyword(s):  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Foramen Magnum ◽  
Atlantoaxial Joint ◽  
Lateral Mass ◽  
Content Type ◽  
Joint Distraction ◽  
History Of ◽  
Fine Print

Object. The author discusses the successful preliminary experience of treating selected cases of basilar invagination by performing atlantoaxial joint distraction, reduction of the basilar invagination, and direct lateral mass atlantoaxial plate/screw fixation. Methods. Twenty-two patients with basilar invagination—in which the odontoid process invaginated into the foramen magnum and the tip of the odontoid process was above the Chamberlain, McRae foramen magnum, and Wackenheim clival lines—were selected to undergo surgery. In all patients fixed atlantoaxial dislocations were documented. The 16 male and six female patients ranged in age from 8 to 50 years. A history of trauma prior to the onset of symptoms was documented in 17 patients. Following surgery, the author observed minimal-to-significant reduction of basilar invagination and alteration in other craniospinal parameters resulting in restoration of alignment of the tip of the odontoid process and the clivus and the entire craniovertebral junction in all patients. In addition to neurological and radiological improvement, preoperative symptoms of torticollis resolved significantly in all patients. The minimum follow-up period was 12 months and the mean was 28 months. Conclusions. Joint distraction and firm lateral mass fixation in selected cases of basilar invagination is a reasonable surgical treatment for reducing the basilar invagination, restoring craniospinal alignment, and establishing fixation of the atlantoaxial joint.

Results and risk factors for anterior cervicothoracic junction surgery

2001 ◽  
Vol 94 (1) ◽  
pp. 12-17 ◽  
Author(s):  
John A. Boockvar ◽  
Matthew F. Philips ◽  
Albert E. Telfeian ◽  
Donald M. O'Rourke ◽  
Paul J. Marcotte
Keyword(s):  
Risk Factors ◽  
Anterior Approach ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Significant Risk ◽  
Cervicothoracic Junction ◽  
Content Type ◽  
Cervical Approach ◽  
Anterior Cervical Approach ◽  
Four Levels ◽  
Fine Print

Object. Stabilization of the cervicothoracic junction (CTJ) requires special attention to the operative approach and biomechanical requirements of the fixation construct. In this study the authors assess the morbidity associated with the anterior approach to the CTJ and define risks that may lead to construct failure after anterior CTJ surgery. Methods. Data obtained for 14 patients (six men and eight women, mean age 50.1 years) who underwent surgical stabilization of the CTJ via an anterior cervical approach were retrospectively reviewed to assess the anterior approach—related morbidity and the risks of construct failure. The mean follow-up period was 21.1 months. Four patients (29%) had previously undergone CTJ surgery; in 11 patients (64%) more than one motion segment was involved (two levels, six patients; three levels, four patients; four levels, one patient); allograft was placed in three (21%) of 14 graft sites; and anterior plates were used for reconstruction augmentation in eight patients (57%). Postoperatively all patients improved, although four patients had residual deficits or pain. Graft/plate failure, requiring surgical revision and/or halo placement, occurred in five patients (36%). One patient experienced transient recurrent laryngeal nerve palsy. Postoperatively, the authors classified patients into one of two groups: those in whom surgery was successful (nine cases) and those in whom it had failed (five cases). Analysis of the characteristics of these two groups revealed that male sex (p < 0.0365), multiple levels of involvement (p < 0.0378), and the use of allograft as compared with autograft (p < 0.0088) were significant risk factors for construct failure. Prior CTJ surgery (p < 0.053) tended to be associated with graft failure. Conclusions: Findings of this study, in the setting of these factors, indicate that anterior reconstruction alone may not meet the biomechanical needs of this spinal region and that supplementary fixation may be considered to augment stabilization for fusion success.

Variations of the extreme-lateral craniocervical approach: anatomical study and clinical analysis of 69 patients

1999 ◽  
Vol 90 (1) ◽  
pp. 206-219 ◽  
Author(s):  
Eduardo Salas ◽  
Laligam N. Sekhar ◽  
Ibrahim M. Ziyal ◽  
Anthony J. Caputy ◽  
Donald C. Wright
Keyword(s):  
Cervical Spine ◽  
Medulla Oblongata ◽  
Sigmoid Sinus ◽  
Vascular Lesions ◽  
Upper Cervical Spine ◽  
Content Type ◽  
Bypass Procedure ◽  
Transcondylar Approach ◽  
Upper Cervical ◽  
Fine Print

Object. The aim of this study was to describe six variations of the extreme-lateral craniocervical approach, their application, and treatment results. Methods. During a 4-year period 69 patients underwent surgery in which six variations of the extreme-lateral craniocervical approach were performed. The variations included: the transfacetal approach (TFA), performed to treat four lesions in the upper cervical spine anterior or anterolateral to the spinal cord; the retrocondylar approach, to treat five intradural lesions located anterolateral to the medulla oblongata and six vascular lesions to expose the extradural segment of the vertebral artery (VA); the partial transcondylar approach (PTCA), to treat 18 intradural lesions located anterior to the medulla oblongata; the complete transcondylar approach (CTCA), to treat 13 extradural lesions that involved the lower clivus and anterior upper cervical spine; the extreme-lateral transjugular approach, to treat 14 jugular foramen tumors; and the transtubercular approach with or without division of the sigmoid sinus, to treat complex VA and vertebrobasilar junction aneurysms. An anatomical prosection was performed to study the surgical exposure of each of the six variations of the extreme-lateral craniocervical approach. Total removal was achieved in 35 (69%) of the patients with tumor; subtotal resection was achieved in 16 (31%) of those patients. In the 12 patients with VA aneurysms, seven underwent clipping, three underwent trapping and a vein graft bypass procedure, and two underwent trapping without the use of a bypass procedure. In five other patients, different cystic, inflammatory, and other vascular lesions were successfully treated. Fifty percent of the patients who underwent surgery via the TFA, 83% via the of the CTCA, and 11% via the PTCA required an occipitocervical fusion procedure. The mean Karnofsky Performance Scale score was 74.7 preoperatively and 76.4 postoperatively. Major complications were hydrocephalus (nine patients), cerebrospinal fluid leakage (seven patients), worsened cranial nerve function (seven patients), vertebrobasilar vasospasm (one patient), and sigmoid sinus thrombosis (one patient). Conclusions. To treat lesions in the region of the foramen magnum and surrounding areas, the approach should be tailored to each specific lesion to provide the needed exposure without unnecessary operative steps.

Fracture of a sublaminar stainless steel cable in the upper cervical spine with neurological injury

1994 ◽  
Vol 81 (6) ◽  
pp. 932-933 ◽  
Author(s):  
J. Bob Blacklock
Keyword(s):  
Stainless Steel ◽  
Cervical Spine ◽  
Spinal Canal ◽  
Neurological Injury ◽  
Upper Cervical Spine ◽  
Steel Cable ◽  
Content Type ◽  
Atlantoaxial Fusion ◽  
Upper Cervical ◽  
Fine Print

✓ Sublaminar cables have been used to stabilize bone grafts for arthrodesis in the cervical spine in recent years. Previous accounts of their use have indicated no instances of breakage or neurological injury. This report is of a delayed cable fracture that resulted in penetration of the dura with neurological injury in a patient who had undergone atlantoaxial fusion for rheumatoid subluxation. The cable fracture occurred in the epidural space beneath the attempted arthrodesis and resulted in uncoiling of the cable, which penetrated the spinal canal and caused a one-sided sensory deficit.

Spectrum of the hangman's fracture

1976 ◽  
Vol 45 (1) ◽  
pp. 3-8 ◽  
Author(s):  
Edward L. Seljeskog ◽  
Shelley N. Chou
Keyword(s):  
Basic Mechanism ◽  
Upper Cervical Spine ◽  
Fracture Treatment ◽  
Mechanism Of Injury ◽  
Hangman’S Fracture ◽  
Content Type ◽  
Upper Cervical ◽  
Fracture Instability ◽  
Hangman's Fracture ◽  
Fine Print

✓ The authors review their experience in managing 26 cases of “hangman's fracture.” The basic mechanism of injury was hyperextension of the upper cervical spine. Radiographic studies revealed a spectrum of injury beginning with the classical hangman's fracture and progressing to the simple C-2 laminar-pedicle fracture. Appreciation of the fracture instability will dictate the method and duration of fracture treatment. Management by a closed, nonoperative means resulted in solid union of the bone in all fully treated cases, with a minimum of morbidity.

Extreme lateral transcondylar approach for resection of ventrally based meningioma of the craniovertebral junction and upper cervical spine

2012 ◽  
Vol 33 (Suppl1) ◽  
pp. 1
Author(s):  
James K. Liu
Keyword(s):  
Cervical Spine ◽  
Cervical Spinal Cord ◽  
Close Association ◽  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Upper Cervical Spine ◽  
Transcondylar Approach ◽  
Intradural Tumor ◽  
Upper Cervical ◽  
Microsurgical Resection

Ventrally based meningiomas at the craniovertebral junction can be challenging tumors to remove because of their deep location anterior to the lower brainstem and upper cervical spinal cord, and close association with complex neurovascular structures. The extreme lateral transcondylar approach provides excellent access and exposure to anterior and anterolateral intradural tumors involving the region of the craniovertebral junction, including the lower third of the clivus, the foramen magnum, and the upper cervical spine. This approach allows safe access for removal of these difficult tumors without any neural retraction. In this operative video manuscript, the author demonstrates an illustrative step-by-step technique for microsurgical resection of a ventrally based meningioma extending from the foramen magnum to C-2 using the extreme lateral transcondylar approach. The operative technique and surgical nuances, including the surgical approach, intradural tumor removal, and cranial base reconstruction, are illustrated in this video atlas. The video can be found here: http://youtu.be/4uvPpEtEShU.

Traumatic atlantooccipital dislocation

1977 ◽  
Vol 46 (5) ◽  
pp. 663-666 ◽  
Author(s):  
Alan H. Fruin ◽  
Thomas P. Pirotte
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injuries ◽  
Upper Cervical Spine ◽  
Nerve Injuries ◽  
Content Type ◽  
Traumatic Dislocation ◽  
Upper Cervical ◽  
Cranial Nerve Injuries ◽  
Atlantooccipital Dislocation ◽  
Fine Print

✓ A case of traumatic atlantooccipital dislocation is presented and the literature reviewed. This type of traumatic dislocation is probably produced by violent hyperextension of the upper cervical spine. Cranial nerve injuries and spinal cord injuries are common. Early fusion is recommended.

scholarly journals Management of C2-C3 fracture subluxation by anterior cervical approach and C2-C3 trans-cortical screw placement

2018 ◽  
Vol 32 (1) ◽  
pp. 170-173
Author(s):  
Amit Agrawal
Keyword(s):  
Cervical Spine ◽  
Morbidity And Mortality ◽  
Screw Placement ◽  
Upper Cervical Spine ◽  
Cervical Spine Injuries ◽  
Cortical Screw ◽  
Spine Injuries ◽  
Upper Cervical ◽  
Cervical Approach ◽  
Anterior Cervical Approach

AbstractCervical spine injuries are the major cause of morbidity and mortality in trauma victims. Upper cervical spine injuries account for about 24% of acute fractures and dislocations and one third of fractures occur at the level of C2, while one half of injuries occur at the C6 or C7 levels. In contrast to this approach we used the transverse cervical, platysma splitting incision at a lower (C3-C4 disc) to expose the upper cervical spine particularly lower border of C3 (entry point for the screw).

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