This technique can be useful in cases when the C1 posterior arch is fractured or a C1 laminectomy is required. Therefore, it has the advantages and strengths of both techniques. The C1 lateral mass screw with C1-C2 transarticular screw is a novel posterior atlantoaxial fixation technique for atlantoaxial instability and is based on established posterior atlantoaxial fixation techniques. Posterior wiring techniques and interlaminar clamps are nowadays completely replaced by rigid screw fixations of the atlas and axis (e.g., techniques of Magerl and Harms/Goel). Therefore, atlantoaxial immobilization by instrumentation is challenging. This range of motion even increases if components of the C1-C2 motion segment are damaged by trauma, inflammation, neoplasm, or congenital defects. The C1-C2 motion segment has the widest range of movement of any spinal motion segment. We were able to demonstrate that the combination of C1 lateral mass screws with C1-C2 transarticular screws is a safe and solid technique for posterior atlantoaxial fixation based on well-established posterior atlantoaxial fixation techniques. Bone graft was placed in the interlaminar space or laterally in the facet joint. Then, the polyaxial screws were fixed with rods. After drilling at the decorticated C1 lateral mass and under fluoroscopy, a polyaxial screw was inserted. The lateral part of the C1 arch, which overlies the lateral mass below the sulcus arteriosus, was drilled until the lateral mass was exposed. The C2 nerve root was identified and mobilized inferiorly. Next, the dorsal arch of C1 was exposed laterally. A polyaxial screw, typically 40 mm in length, was placed. Surgical techniqueĪfter the routine midline approach, the inferior facet of C2 was docked, and drilling was performed through the C1-C2 facet joint to the level of the anterior arch of C1 under fluoroscopy, within the lateral mass of C1. All patients had preoperative thin-sliced computerized tomography (CT) scan and/or CT-angiography to confirm the course of the vertebral artery and to detect any anomalies. We reviewed the records of 14 patients averaging 62 years of age who underwent atlantoaxial fixation using both C1 lateral mass screws and C1-C2 transarticular screws (2012–2017). Keywords: Atlantoaxial instability, C1-C2 Fixation, craniocervical junction, odontoid fracture, os odontoideum Furthermore, all patients exhibited postoperative improvement in neck pain.Ĭonclusions:C1 lateral mass and C1-C2 transarticular polyaxial screw rod fixation techniques were effective in achieving immediate rigid immobilization of the C1-C2 motion segment. Postoperative imaging showed no screw malpositioning, and no screw loosening, fracture, or bone absorption around the screws. Results:Intraoperatively, there were no complications (e.g., vertebral artery, nerve root, or spinal cord injury). Ten patients underwent posterior C1-C2 fixation, three patients with osteoporosis had C1-C4 fixation, and one patient had C1-Th1 fixation. Methods:We retrospectively reviewed 14 patients (7 women, 7 men mean age 62) who underwent surgery for type II odontoid fractures ( n = 7), pseudarthrosis after anterior odontoid screw placement ( n = 3), Os odontoideum ( n = 2), atlantoaxial instability after C3-C5 fusion ( n = 1), and craniovertebral rheumatoid arthritis ( n = 1). Here, we present a novel technique utilizing a polyaxial screw rod system and a combination of C1 lateral mass and C1-C2 transarticular screws. Background:There are several techniques for treating atlantoaxial instability, including the Magerl transarticular screw fixation and the Harms/Goel C1-C2 screw rod techniques.
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