Feasibility of Occipital Condyle Screw Placement for Occipitocervical Fixation

Uribe, Juan S.; Ramos, Edwin; Vale, Fernando Ĺ.

doi:10.1097/bsd.0b013e31816d655e

Cited by 67 publications

(58 citation statements)

References 38 publications

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“…4 This procedure was based on prior publications validating the technique in cadavers. 31 Our technique, used in the pediatric cases described here, was adapted from previous work published by Frankel et al 6 analyzing the occipital condyles in 40 patients using CT scans, and confirming screw length, trajectory, and feasibility in 4 adult cadavers. From this analysis the authors concluded that, on average, a 3.5-mm-diameter screw, 20-to 30-mm in length, can be safely placed at an angle of 20°-33° from the sagittal plane (Fig.…”

Section: Discussionmentioning

confidence: 99%

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Occipital condyle to cervical spine fixation in the pediatric population

Kosnik-Infinger

Glazier

Frankel

2014

PED

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Fixation at the craniovertebral junction (CVJ) is necessary in a variety of pediatric clinical scenarios. Traditionally an occipital bone to cervical fusion is preformed, which requires a large amount of hardware to be placed on the occiput of a child. If a patient has previously undergone a posterior fossa decompression or requires a decompression at the time of the fusion procedure, it can be difficult to anchor a plate to the occipital bone. The authors propose a technique that can be used when faced with this difficult challenge by using the occipital condyle as a point of fixation for the construct. Adult cadaveric and a limited number of case studies have been published using occipital condyle (C-0) fixation. This work was adapted for the pediatric population. Between 2009 and 2012, 4 children underwent occipital condyle to axial or subaxial spine fixation. One patient had previously undergone posterior fossa surgery for tumor resection, and 1 required decompression at the time of operation. Two patients underwent preoperative deformity reduction using traction. One child had a Chiari malformation Type I. Each procedure was performed using polyaxial screw-rod constructs with intraoperative neuronavigation supplemented by a custom navigational drill guide. Smooth-shanked 3.5-mm polyaxial screws, ranging in length from 26 to 32 mm, were placed into the occipital condyles. All patients successfully underwent occipital condyle to cervical spine fixation. In 3 patients the construct extended from C-0 to C-2, and in 1 from C-0 to T-2. Patients with preoperative halo stabilization were placed in a cervical collar postoperatively. There were no new postoperative neurological deficits or vascular injuries. Each patient underwent postoperative CT, demonstrating excellent screw placement and evidence of solid fusion. Occipital condyle fixation is an effective option in pediatric patients requiring occipitocervical fusion for treatment of deformity and/or instability at the CVJ. The use of intraoperative neuronavigation allows for safe placement of screws into C-0, especially when faced with a challenging patient in whom fixation to the occipital bone is not possible or is less than ideal.

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Section: Discussionmentioning

confidence: 99%

“…Adult cadaveric studies have demonstrated the occipital condyles (C-0) to be a feasible fixation point. 4,6,13,14,21,[30][31][32] Subsequently, successful demonstration of this technique has been reported in adults 6,30 and in 1 pediatric patient. 4 In this paper, we present a series of 4 pediatric patients using our described technique.…”

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confidence: 99%

Occipital condyle to cervical spine fixation in the pediatric population

Kosnik-Infinger

Glazier

Frankel

2014

PED

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“…7,8,13,19,20) The theoretical advantage of condylar screw fixation is the lower profile and no dependence on the thickness of the occipital bone. Furthermore, there is no risk of creating potential epidural hematoma.…”

Section: Introductionmentioning

confidence: 99%

“…One of the biggest concerns is the anatomical feasibility of placing the screw at the occipital condyle. 13,20) Screw malposition may cause major complications involving the medulla, hypoglossal nerve, venous plexus, or vertebral artery. Another concern is the biomechanical strength of these screw constructs.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical and Morphometric Evaluation of Occipital Condyle for Occipitocervical Segmental Fixation

Hong

Takigawa

Sugisaki

et al. 2011

Neurol. Med. Chir.(Tokyo)

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Two recent novel techniques of occipital fixation are the occipitoatlantal (C0-C1) transarticular screw technique and the direct occipital condyle screw technique. The present study evaluated and compared the biomechanical stability of the direct occipital condyle screw and C0-C1 transarticular screw with the established method for craniocervical spine fixation using the midline occipital keel screw and C1 lateral mass screw. Morphometric evaluation of the occipital condyle and the hypoglossal canal was performed to avoid hypoglossal nerve injury during the screw placement. Thirteen recently frozen cadaveric specimens were used. The occipital condyle anatomy and the hypoglossal canal dimension were measured using reconstructed computed tomography images. Insertion torque and pullout strength were evaluated to compare the midline occipital keel screw, C0-C1 transarticular screw, C1 lateral mass screw, and direct occipital condyle screw. The dimensions of the occipital condyle allow use of a 3.5 or 4.0-mm diameter screw. Mean pullout strength was 1619.6 N for the midline occipital keel screw, 870.7 N for the C0-C1 transarticular screw, 707.0 N for the C1 lateral mass screw, and 431.7 N for the direct occipital condyle screw. Mean insertion torque was 0.55 Nm for the midline occipital keel screw, 0.32 Nm for the C0-C1 transarticular screw, 0.14 Nm for the C1 lateral mass screw, and 0.11 Nm for the direct occipital condyle screw. The condylar anatomy allows direct insertion of the occipital condyle screw and C0-C1 transarticular screw. These techniques are suitable options for the treatment of craniovertebral junction instabilities in selected patients.

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“…In our technique, the condylar entry point corresponds to the midcondylar area, 4 to 5 mm lateral to the foramen magnum on the axial plane and 1 to 2 mm rostral to the atlantooccipital joint. 4 In the technique of Frankel et al, caudal-cranial angulation is determined by placing the hand drill in the pilot hole with its shaft tangential to and abutting the skull base. Depending on condylar, skull base, and hypoglossal canal anatomy, the overall trajectory of occipital condyle screws is usually 10° cranial or caudal to the horizontal plane.…”

Section: Occipital Condyle To Cervical Spine Screw and Rod Fixationmentioning

confidence: 99%

Letters to the editor: Occipital condyle to cervical spine screw and rod fixation

Uribe¹,

Ramos²,

Youssef³

et al. 2014

SPI

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Feasibility of Occipital Condyle Screw Placement for Occipitocervical Fixation

Abstract: Condyle screws can be placed without injury to neurovascular structures. OC junction fixation using polyaxial occipital condyle screws is feasible and can be considered a salvage technique or an alternative where other fixation techniques are not available.

Cited by 67 publications

References 38 publications

Occipital condyle to cervical spine fixation in the pediatric population

Occipital condyle to cervical spine fixation in the pediatric population

Biomechanical and Morphometric Evaluation of Occipital Condyle for Occipitocervical Segmental Fixation

Letters to the editor: Occipital condyle to cervical spine screw and rod fixation

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