Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications, and lessons learned in 67 pediatric patients

Gluf, Wayne M.; Brockmeyer, Douglas L.

doi:10.3171/spi.2005.2.2.0164

Cited by 157 publications

(114 citation statements)

References 20 publications

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“…8,9,[12][13][14]16,17,19,21,25,32 One type of upper cervical spine injury, atlantooccipital dislocation (AOD), is a severe injury associated with high mortality rates. 1,2,11,12,[16][17][18][19][20]22,24 In postmortem examinations, evidence of AOD is present in 20%-31% of deaths due to cervical spine injuries.…”

mentioning

confidence: 99%

Computed tomography parameters for atlantooccipital dislocation in adult patients: the occipital condyle–C1 interval

Martinez-del-Campo

Kalb

Soriano-Baron

et al. 2016

SPI

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OBJECT Atlantooccipital dislocation (AOD) in adults cannot be diagnosed with adequate specificity and sensitivity using only CT or plain radiography, and the spine literature offers no guidelines. In children, the most sensitive and specific radiographic measurement for the diagnosis of AOD is the CT-based occipital condyle–C1 interval (CCI). The goal of the current study was to identify the normal CCI in healthy adults and compare it with the CCI in adults with AOD to establish a highly sensitive and specific cutoff value for the neuroimaging diagnosis of AOD. METHODS A total of 81 patients, 59 without AOD and 22 with AOD, were included in this study. Measurements obtained from thin-slice CT scans of the craniovertebral joint to assess atlantooccipital dislocation included the CCI, condylar sum, the Wholey and Harris intervals, Powers and Sun ratios, Wackenheim line, and Lee X-lines. RESULTS The group of patients without AOD included 30 men (50.8%) and 29 women (49.2%) with a mean age of 42.4 ± 16 years (range 19–87 years). The group of patients with AOD included 10 men (45.5%) and 12 women (54.5%) with a mean age of 38.2 ± 9.7 years (range 20–56 years). Interrater reliabilities within a 95% CI were all greater than 0.98 for CCI measurements. A total of 1296 measurements of the CCI were made in 81 patients. The mean CCI for non-AOD patients was 0.89 ± 0.12 mm, the single largest CCI measurement was 1.4 mm, and the largest mean for either right or left CCI was 1.2 mm. The mean condylar sum was 1.8 ± 0.2 mm, and the largest condylar sum value was 2.2 mm. Linear regression with age predicted an increase in CCI of 0.001 mm/year (p < 0.05). The mean CCI in AOD patients was 3.35 ± 0.18 mm (range 1.5 mm–6.4 mm). The shortest single CCI measurements in the AOD patients were 1.1 mm and 1.2 mm. The mean condylar sum for all 22 AOD patients was 6.7 ± 2.7 mm and the shortest condylar sums were 3.0 mm. Cutoff values for AOD were set at 1.5 mm for the CCI and 3.0 mm for the condylar sum, both with a sensitivity of 1 and false-negative rate of 0. Sensitivity for the Powers, Wholey, Harris, Sun, Wackenheim, and Lee criteria were determined to be 0.55, 0.46, 0.27, 0.23, 0.41, and 0.41, respectively. CONCLUSIONS The CCI is shorter in adult patients as opposed to the pediatric population. The revised CCI (1.5 mm) and condylar sum (3.0 mm) cutoff values have the highest sensitivity and specificity for the diagnosis of AOD in the adult population.

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confidence: 99%

Computed tomography parameters for atlantooccipital dislocation in adult patients: the occipital condyle–C1 interval

Martinez-del-Campo

Kalb

Soriano-Baron

et al. 2016

SPI

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“…C1-2 transarticular screws have been shown to be very effective at providing a solid fusion construct in pediatric patients with atlantoaxial instability [1,2,6,18]. While transarticular screws can be safe and effective choice, their placement is technically demanding and in some patients, there are some potential advantages to the use of a GoelHarms construct.…”

Section: Discussionmentioning

confidence: 99%

“…In most studies on C1-2 fusion autograft was taken from the hip or rib [1,2,5,7,8,13,18,20,23,25]. Goel-Harms constructs do not require a structural graft so hip graft may not be needed.…”

Section: Discussionmentioning

confidence: 99%

“…Traditional posterior wiring techniques, including Brooks and Gallie fusions, have a long history of success in all age groups [7,8,16,29]. More recently, the introduction of transarticular C1-2 fusions have been described and when technically possible have been shown to be effective in adults as well as pediatric patients [1,2,6,13,18,19,39]. …”

Section: Introductionmentioning

confidence: 99%

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Treatment of pediatric atlantoaxial instability with traditional and modified Goel–Harms fusion constructs

et al. 2009

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There are several treatment options for rigid fixation at C1-C2 including Brooks and Gallie type wired fusions and C1-2 transarticular screws. The use of a GoelHarms type fusion, a construct with C1 lateral mass screws and C2 pedicle screws, has not been extensively described in pediatric patients. Here, we describe its relatively safe and effective use for treating pediatric patients by retrospective chart review of patients treated by the senior author for atlantoaxial instability with a Goel-Harms-type constructs during a 3-year period (2005)(2006)(2007). Six patients were treated using Goel-Harms-type constructs. Five patients were treated utilizing a construct containing C1 lateral mass screws and C2 pedicle screws; one patient was treated using construct containing C1 lateral mass screws and C2 trans-laminar screws. The patients ranged in age from 7 to 17 years old (mean 12.7). All patients had findings of an os odontoideum on CT scans and three of the six patients had T2 hyperintensity on MRI. Three of the six patients presented with transient neurologic deficits: quadraplegia in two patients and paresthesias in two patients. In each patient C1 lateral mass and C2 screws were placed and the subluxation was reduced to attain an anatomical alignment. No bone grafts were harvested from the iliac crest or rib. Local morsalized bone and sub-occipital skull graft was used. All patients tolerated the procedure well and were discharged home on post-operative day 3-4. The patients wore a hard cervical collar and no halo-vests were needed. All patients had solid fusion constructs and normal alignment on post-operative imaging studies performed on average 14 months post-operatively (range: 7-29). The results demonstrated that Goel-Harms fusions are a relatively safe and effective method of treating pediatric patients with atlantoaxial instability and are not dependent on vertebral anatomy or an intact ring of C1. Follow-up visits and studies in this limited series of patients demonstrated solid fusion constructs and anatomical alignment in all patients treated.

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“…Brockmeyer has published a separate series using transarticular screws in young children, although even in experienced hands the risk to the vertebral artery is present [2,7]. As with all upper cervical screw constructs, planning for transarticular screws must be made via CT analysis of the position of the vertebral artery and size of the C2 isthmus (Fig.…”

Section: Transarticular Screwsmentioning

confidence: 99%

Modern Instrumentation of the Pediatric Occiput and Upper Cervical Spine

Hedequist

2014

HSS Jrnl

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Background: Rigid screw rod techniques for cervical stabilization are widely used in adults. The benefits of rigid internal fixation include increased fusion rates, improvements in deformity correction, and diminished immobilization requirements. Applications of these techniques in children are challenging due to size constraints and the pathologic conditions encountered which require instrumented cervical fusions. Preparation as well as thorough understanding of the anatomy and surgical techniques is paramount to surgical safety in pediatric patients. Questions/Purposes: This review article serves as an educational tool regarding the use of modern posterior instrumentation techniques for pediatric cervical deformity. Methods: Expert review based on clinical expertise and literature review. Results: The use of rigid screw rod instrumentation for the pediatric occiput and upper cervical spine is discussed. Preoperative imaging requirements for pediatric patients undergoing cervical spine surgery are reviewed. Anatomy, morphologic studies, and surgical techniques are discussed for each area of instrumentation. Conclusions: Modern posterior cervical instrumentation techniques can be safely applied to the majority of pediatric patients who require an instrumented posterior cervical fusion. Patient safety revolves around thorough preoperative imaging tests, understanding of upper cervical anatomy, and meticulous surgical technique. Modern instrumentation leads to an improvement in fusion rates and a diminishment in immobilization requirements.

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Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications, and lessons learned in 67 pediatric patients

Cited by 157 publications

References 20 publications

Computed tomography parameters for atlantooccipital dislocation in adult patients: the occipital condyle–C1 interval

Computed tomography parameters for atlantooccipital dislocation in adult patients: the occipital condyle–C1 interval

Treatment of pediatric atlantoaxial instability with traditional and modified Goel–Harms fusion constructs

Modern Instrumentation of the Pediatric Occiput and Upper Cervical Spine

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