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.

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.

Clinical Outcome of Dorsal Cervical C1–C2 Fusion Using C1 Lateral Mass Screws, C2 Lamina Screws, and Interarcual Bone Graft Technique

2019 ◽  
Vol 81 (03) ◽  
pp. 200-206
Author(s):  
Dominik Baschera ◽  
Lazar Tosic ◽  
Joachim Oberle ◽  
Jagos Golubovic ◽  
Alex Alfieri
Keyword(s):  
Neck Pain ◽  
Bone Graft ◽  
Clinical Results ◽  
Fusion Rate ◽  
Implant Failure ◽  
Bony Union ◽  
Lateral Mass ◽  
Root Injury ◽  
Lateral Mass Screws

Aims To evaluate the clinical and radiologic results of patients treated with dorsal cervical C1–C2 fusion using C1 lateral mass screws, C2 lamina screws, and interarcual bone graft. Methods We retrospectively analyzed the clinical and radiologic results of eight patients treated from 2011 to 2016. Neck pain, neurologic deficits, use of analgesics, vertebral artery injury, C2 root injury, radiologic fusion rate, malposition of screws, and implant failure were examined on day 3 and at 3 and 12 months postoperatively. Results One patient required revision surgery for a right-sided medial cutout of a lamina screw. None of the patients had vascular or neurologic complications. All patients were pain free and had ceased all analgesic therapy at the first follow-up examination. At the 1-year follow-up there were no complaints of neck pain, no radiologic signs of implant failure were found, and a bony union between C1 and C2 was present in all patients. Conclusion Dorsal cervical C1–C2 fusion using C1 lateral mass screws, C2 lamina screws, and interarcual bone graft are less common techniques, although they can be used safely and demonstrated excellent clinical results with regard to pain relief and a high fusion rate. The technique is an ideal alternative when other techniques are not safe for anatomical reasons.

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 the pullout strengths of C1 lateral mass screws and C1 posterior arch screws

2013 ◽  
Vol 13 (12) ◽  
pp. 1892-1896 ◽  
Author(s):  
Christopher M. Zarro ◽  
Steven C. Ludwig ◽  
Adam H. Hsieh ◽  
Charles N. Seal ◽  
Daniel E. Gelb
Keyword(s):  
Posterior Arch ◽  
Lateral Mass ◽  
Lateral Mass Screws ◽  
Biomechanical Comparison

Versatile Usage of the Modified Lateral Mass Screw as an Alternative to Cervical Pedicle Screw Fixation

2021 ◽  
Author(s):  
Moon-Kyu Kim ◽  
Jung-Jae Lee ◽  
Su-Hee Cho ◽  
Dai-Soon Kwak
Keyword(s):  
Screw Fixation ◽  
Pedicle Screws ◽  
Clinical Results ◽  
Pedicle Screw Fixation ◽  
Complete Fusion ◽  
Lateral Mass ◽  
Screw Misplacement ◽  
Cervical Pedicle ◽  
Cervical Pedicle Screws ◽  
Lateral Mass Screws

Abstract Objective Posterior subaxial cervical screw fixation is commonly performed using the cervical pedicle screws (CPS) and lateral mass screws (LMS); however, their compatibility is low. Modified lateral mass screws (mLMS, also called paravertebral foramen screw) fixation was introduced as a salvage technique for LMS fixation and has features of both LMS and CPS techniques. In the present study, the use of mLMS as an alternative to CPS was analyzed based on clinical results. Methods Seventy-eight screws (38 CPSs and 40 mLMSs) were inserted into 12 patients. The misplacement of the screws was evaluated by computed tomography (CT). The failure of instrumentation and instability were evaluated using plain radiographs. Results The total number of CPS misplacements was 3 (10.5%); however, neurologic complications were not observed. mLMSs were used in the middle segments of the fusion in 10 patients and 2 patients had mLMS fixation for single-level fusion. An additional bridging implant was not required for connecting both CPSs and mLMSs. Instability was not observed during the observation period (4–51 months). Complete fusion was seen in 10 patients. Conclusions The alternative mLMS fixation can decrease the risk of screw misplacement compared with CPS fixation alone and achieves adequate stability leading to fusion.

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.

Biomechancial Comparison of a Novel C1 Posterior Locking Plate With the Harms Technique in a C1-C2 Fixation Model

2008 ◽  
Author(s):  
Brian P. Kelly ◽  
John A. Glaser ◽  
Denis J. DiAngelo
Keyword(s):  
Locking Plate ◽  
Screw Fixation ◽  
Lateral Mass ◽  
Cervical Nerve Root ◽  
Cervical Nerve ◽  
Fixation Screw ◽  
Atlantoaxial Stabilization ◽  
Lateral Mass Screws ◽  
C2 Fixation ◽  
Harms Technique

Current methods of atlantoaxial stabilization rely on screw fixation. Screw placement may be transarticular, or C1 lateral mass screws in combination with pedicle or pars screws at C2. These techniques can put the vertebral artery at risk. There is also dissection around the ganglion of the second cervical nerve root, which can lead to significant bleeding or postoperative pain.

Biomechanical comparison of occipitoatlantal screw fixation techniques

2008 ◽  
Vol 8 (2) ◽  
pp. 143-152 ◽  
Author(s):  
Nicholas C. Bambakidis ◽  
Iman Feiz-Erfan ◽  
Eric M. Horn ◽  
L. Fernando Gonzalez ◽  
Seungwon Baek ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Axial Rotation ◽  
Segmental Motion ◽  
Lateral Mass ◽  
Lateral Bending ◽  
Flexion Extension ◽  
Improved Stability ◽  
Fixation Techniques ◽  
Structural Graft ◽  
Lateral Mass Screws

Object The stability provided by 3 occipitoatlantal fixation techniques (occiput [Oc]–C1 transarticular screws, occipital keel screws rigidly interconnected with C-1 lateral mass screws, and suboccipital/sublaminar wired contoured rod) were compared. Methods Seven human cadaveric specimens received transarticular screws and 7 received occipital keel–C1 lateral mass screws. All specimens later underwent contoured rod fixation. All conditions were studied with and without placement of a structural graft wired between the skull base and C-1 lamina. Specimens were loaded quasistatically using pure moments to induce flexion, extension, lateral bending, and axial rotation while recording segmental motion optoelectronically. Flexibility was measured immediately postoperatively and after 10,000 cycles of fatigue. Results Application of Oc–C1 transarticular screws, with a wired graft, reduced the mean range of motion (ROM) to 3% of normal. Occipital keel–C1 lateral mass screws (also with graft) offered less stability than transarticular screws during extension and lateral bending (p < 0.02), reducing ROM to 17% of normal. The wired contoured rod reduced motion to 31% of normal, providing significantly less stability than either screw fixation technique. Fatigue increased motion in constructs fitted with transarticular screws, keel screws/lateral mass screw constructs, and contoured wired rods, by means of 19, 5, and 26%, respectively. In all constructs, adding a structural graft significantly improved stability, but the extent depended on the loading direction. Conclusions Assuming the presence of mild C1–2 instability, Oc–C1 transarticular screws and occipital keel–C1 lateral mass screws are approximately equivalent in performance for occipitoatlantal stabilization in promoting fusion. A posteriorly wired contoured rod is less likely to provide a good fusion environment because of less stabilizing potential and a greater likelihood of loosening with fatigue.

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