Atlantoaxial fusion: a biomechanical analysis of two C1–C2 fusion techniques

Claybrooks, Roderick; Kayanja, Mark; Milks, Ryan; Benzel, Edward C.

doi:10.1016/j.spinee.2006.08.010

Cited by 103 publications

(57 citation statements)

References 23 publications

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“…Modern instrumentation makes the Harms-Goel a commonly accepted fixation strategy, with C1 lateral mass screws and C2 pars/pedicle screws. Wright has described the C2 intralaminar screw as another fixation option for C2, providing adequate biomechanical stability [29,30]. Intralaminar screws may also help limit distal dissection and are useful when vertebral artery anatomy precludes pedicle or pars fixation (Fig.…”

Section: Nonoperative Managementmentioning

confidence: 99%

Fractures of the axis: a review of pediatric, adult, and geriatric injuries

Gornet

Kelly

2016

Curr Rev Musculoskelet Med

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Fractures of the second cervical vertebra (C2, axis) are common in adult spine surgery. Those fractures occurring in younger adult patients are often associated with highenergy mechanism trauma, resulting in a "Hangman's Fracture." Management of these fractures is often successful with nonoperative means, though surgery may be needed in those fractures with greater displacement and injury to the C2-C3 disc. Older patients are more likely to sustain fractures of the odontoid process. The evidence supporting surgical management of these fractures is evolving, as there may be a mortality benefit to surgery. Regardless of treatment, longerterm mortality rates are high in this patient population, which should be discussed with the patient and family at the time of injury. Pediatric patients may suffer fractures of the axis, though differentiation of normal and pathologic findings is necessary and more difficult with the skeletally immature spine.

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Section: Nonoperative Managementmentioning

confidence: 99%

Fractures of the axis: a review of pediatric, adult, and geriatric injuries

Gornet

Kelly

2016

Curr Rev Musculoskelet Med

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“…In our cases, C1-2 arthrodesis was performed using C-1 lateral mass and C-2 translaminar screws, which is easier, safer, and faster than other techniques, with good biomechanical results. 4,28 Arguably, because of the learning curve of the surgery, time and blood loss were higher with EEA. We hypothesize that acquiring more experience with the expanded EEA could significantly reduce the surgical time.…”

Section: Discussionmentioning

confidence: 99%

Evolution from microscopic transoral to endoscopic endonasal odontoidectomy

Ponce-Gómez

Ortega-Porcayo

Soriano-Baron

et al. 2014

FOC

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Object The goal of this study was to compare the indications, benefits, and complications between the endoscopic endonasal approach (EEA) and the microscopic transoral approach to perform an odontoidectomy. Transoral approaches have been standard for odontoidectomy procedures; however, the potential benefits of the EEA might be demonstrated to be a more innocuous technique. The authors present their experience with 12 consecutive cases that required odontoidectomy and posterior instrumentation. Methods Twelve consecutive cases of craniovertebral junction instability with or without basilar invagination were diagnosed at the National Institute of Neurology and Neurosurgery in Mexico City, Mexico, between January 2009 and January 2013. The EEA was used for 5 cases in which the odontoid process was above the nasopalatine line, and was compared with 7 cases in which the odontoid process was beneath the nasopalatine line; these were treated using the transoral microscopic approach (TMA). Odontoidectomy was performed after occipital-cervical or cervical posterior augmentation with lateral mass and translaminar screws. One case was previously fused (Oc–C4 fusion). The senior author performed all surgeries. American Spinal Injury Association scores were documented before surgical treatment and after at least 6 months of follow-up. Results Neurological improvement after odontoidectomy was similar for both groups. From the transoral group, 2 patients had postoperative dysphonia, 1 patient presented with dysphagia, and 1 patient had intraoperative CSF leakage. The endoscopic procedure required longer surgical time, less time to extubation and oral feeding, a shorter hospital stay, and no complications in this series. Conclusions Endoscopic endonasal odontoidectomy is a feasible, safe, and well-tolerated procedure. In this small series there was no difference in the outcome between the EEA and the TMA; however, fewer complications were documented with the endonasal technique.

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“…those with neurological symptoms or signs as in the present study), we find a significant better prognosis if ankylosis is achieved. To obtain a higher proportion of bony ankylosis we have changed operative method from Brattstrøm and Granholm (1976) to transarticular screws (Claybrooks et al, 2007;Cornefjord et al, 2003;Haid, Jr. et al, 2001;Henriques et al, 2000;Praveen & Regis, 2005) after this study. In our minds, based on the present findings, patients with relevant neurology are late for operation, their prognosis being worse, and we advise that operative treatment is initiated prior to the development of neurological symptoms or signs.…”

Section: Discussionmentioning

confidence: 99%