Posterior Atlantoaxial Fixation with Lateral Mass Screw in the Atlas and Pedicle Screw in the Axis

Shin, Dong-Ah;Kim, Keung-Nyun;Yoon, Do-Heum

  • Published : 20031100

Abstract

Objective : The authors report the successful use of a recently described technique of posterior fixation of the C1 lateral mass and the C2 pedicle with polyaxial screws and rods. Methods : After posterior exposure of the C1-C2 complex, the polyaxial screws were inserted into the lateral mass of C1 and the pedicle of C2 with the guidance of anatomic landmarks and fluoroscopy. Then, the pedicle screws of each side were linked with a rod. Because the C1-C2 pedicle screw fixation was sufficiently rigid, an additional posterior wiring or structural bone graft is unnecessary. Results : The early clinical and radiologic follow-up data indicated solid fusion of C1 and C2 vertebrae with no observed neural or vascular damage related to this technique. Conclusion : The posterior fixation of the C1-C2 complex using polyaxial screws and rods seems to be a reliable technique and an efficient alternative to the more commonly accepted procedures.

Keywords

References

  1. Brooks AL, Jenkins EB : Atlanto-axial arthrodesis by the wedge compression method. J Bone Joint Surg 60A : 279-284, 1978
  2. Goel A : C1-C2 pedicle screw fixation with rigid cantilever beam construct : case report and technical note. Neurosurgery 51 : 853-854, 2002 https://doi.org/10.1097/00006123-200209000-00058
  3. Geremia GK, Kim KS, Cerullo L : Complications of sublaminar wiring. Surg Neurol 23 : 629-635, 1985 https://doi.org/10.1016/0090-3019(85)90017-5
  4. Grob D, Crisco JJ III, Panjabi M, Wang P, Dvorak J : Biomechanical evaluation of four different posterior atlantoaxial fixation techniques. Spine 17 : 480-490, 1992 https://doi.org/10.1097/00007632-199205000-00003
  5. Harms J, Melcher RP : Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine 26 : 2467-2471, 2001 https://doi.org/10.1097/00007632-200111150-00014
  6. Henriques T, Cunningham BW, Olerud C : Biomechanical comparison of five different atlantoaxial posterior fixation techniques. Spine 25 : 2877-2883, 2000 https://doi.org/10.1097/00007632-200011150-00007
  7. Jun BY: Anatomic study for ideal and safe posterior C1-C2 transarticular screw fixation. Spine 23 : 1703-1707, 1998 https://doi.org/10.1097/00007632-199808010-00018
  8. Magerl F, Seemann PS : Stable posterior fusion of the atlas and axis by transarticular screw fixation in Kehr P, Weidner(eds) : Cervical Spine, New York : Springer, 1986, Vol 1, pp322-327
  9. McCullen GM, Garfin SR : Spine update : cervical spine internal fixation using screw and screw-plate constructs. Spine 25 : 643-652, 2000 https://doi.org/10.1097/00007632-200003010-00020
  10. Naderi S, Crawford NR, Song GS : Biomechanical comparison of C1-C2 posterior fixations : Cable, graft, and screw combinations. Spine 23 : 1946-1955, 1998 https://doi.org/10.1097/00007632-199809150-00005
  11. Oda I, Abumi K, Sell LC : Biomechanical evaluation of five different occipito-atlanto-axial fixation techniques. Spine 24 : 2377-2382, 1999 https://doi.org/10.1097/00007632-199911150-00015
  12. Puttlitz CM, Goel VK, Traynelis VC : A finite element investigation of upper cervical instrumentation. Spine 26 : 2449-2455, 2001 https://doi.org/10.1097/00007632-200111150-00011
  13. Resnick DK, Benzel EC : C1-C2 pedicle screw fixation with rigid cantilever beam construct : case report and technical note. Neurosurgery 50 : 426-428, 2002 https://doi.org/10.1097/00006123-200202000-00039
  14. Resnick DK, Lapsiwala S, Trost GR : Anatomic suitability of the C1-C2 complex for pedicle screw fixation. Spine 27 : 1494-1498, 2002 https://doi.org/10.1097/00007632-200207150-00003
  15. Richter M, Wilke HJ, Kluger P : Biomechanical evaluation of a new modular rod-screw implant system for posterior instrumentation of the occipito-cervical spine : in-vitro comparison with two established implant systems. Eur Spine J 9 : 417-425, 2000 https://doi.org/10.1007/s005860000173
  16. Yoon DH, Kim YS : Long term follow up and clinical result of posterior C1/2 fixation. J Korean Neurosurg Soc 28 : 926-933,1999