Analyzing parsicle screws as a viable alternative to pars screws and pedicle screws for C2 posterior instrumentation fixation

Dilbone, Eric S.; Gupta, Rishabh; Stephens, Byron F.

doi:10.1016/j.jor.2021.05.024

Cited by 1 publication

(1 citation statement)

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“…Consequently, a distinguishing feature of patients with sandwich AAD was that salvage fixation techniques, including C2 pedicle screws 21 , C2 translaminar screws 21 , subaxial spinous process screws 21 , C3 spinous process titanium cable wire 22 , and subaxial lateral mass screws 21 , were used in combination with C2 pedicle screws in more than one-third of all cases. Pedicle screw fixation was the primary instrumentation technique of choice in C2 due to its biomechanical advantages 23 , yet its use was limited to selected patients. Previous studies have found that, among patients with C2-C3 nonsegmentation, C2 pedicles were frequently too hypoplastic to safely accommodate a screw ≥3.5 mm in diameter and salvage fixation techniques would then be required for reinforcement 9 .…”

Section: Discussionmentioning

confidence: 99%

Clinical and Surgical Characteristics of Patients with Atlantoaxial Dislocation in the Setting of Sandwich Fusion

Tian

Yue

et al. 2023

Journal of Bone and Joint Surgery

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Background:Patients with “sandwich” fusion (concomitant C1 occipitalization and C2-C3 nonsegmentation), a subtype of Klippel-Feil syndrome, are at particular risk for developing atlantoaxial dislocation (AAD). However, the clinical and surgical characteristics of AAD in patients with sandwich fusion have not been clearly defined.Methods:A retrospective case-control study with a large sample size and a minimum 2-year follow-up was performed. From 2000 to 2018, 253 patients with sandwich AAD underwent a surgical procedure; these patients constituted the case group, and a matching number of patients with non-sandwich AAD were randomly selected to form the control group. Clinical data from electronic medical records and various imaging studies were analyzed and compared. The Japanese Orthopaedic Association (JOA) scale was used to evaluate neurological function.Results:Patients with sandwich AAD, compared with patients with non-sandwich AAD, had symptom onset at a younger age (34.8 compared with 42.8 years; p < 0.001) and had a higher likelihood for myelopathy (87.4% compared with 74.7%; p < 0.001). Patients with sandwich AAD had a higher incidence of lower cranial nerve palsy (7.9% compared with 0.0%; p < 0.001), a lower preoperative JOA score (13.4 compared with 14.2; p < 0.001), and higher incidences of accompanying Type-I Chiari malformation (20.9% compared with 1.2%; p < 0.001) and syringomyelia (21.3% compared with 1.6%; p < 0.001). Finally, patients with sandwich AAD had higher likelihoods of undergoing transoral release (28.5% compared with 5.1%; p < 0.001) and use of salvage fixation techniques (34.4% compared with 6.3%; p < 0.001), and had lower postoperative results for the JOA score (14.9 compared with 15.9; p < 0.001) and improvement rate (43.8% compared with 58.2%; p < 0.001).Conclusions:Patients with sandwich AAD demonstrated distinct clinical manifestations. Versatility involving the use of various internal fixation techniques and transoral release procedures was frequently required in the surgical management of these patients, and meticulous and personalized preoperative planning would be of paramount importance.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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