Modified Gallie Technique Versus Transarticular Screw Fixation in C1-C2 Fusion

Farey, Ian D.; Nadkarni, Sunil; Smith, Nicholas

doi:10.1097/00003086-199902000-00013

Cited by 193 publications

(112 citation statements)

References 31 publications

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“…Placement of either C1-C2 transarticular or C2 pedicle screws has a potential risk of vertebral artery injury [1][2][3][4][5][6][7][8][9][10][11][12][13][14]21]. The risk of vertebral artery injury by these two techniques needs to be carefully analyzed so as to allow the surgeon to choose the appropriate screw insertion method.…”

Section: Discussionmentioning

confidence: 99%

“…Posterior C1-C2 transarticular screw fixation can result in vertebral artery injury, with potentially catastrophic results such as vertebrobasilar insufficiency, brain stem and posterior fossa infarct, and even death [1][2][3]. The rate of vertebral artery injury has been reported to be as high as 8.2% [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

“…The rate of vertebral artery injury has been reported to be as high as 8.2% [1][2][3]. Vertebral artery injuries commonly occur if a drill, tap, or screw perforates or occludes the vertebral artery in the vertebral artery groove of C2, which is located on the lower surface of C2 and lateral to the pedicle ( Fig.…”

Section: Introductionmentioning

confidence: 99%

“…Vertebral artery injuries commonly occur if a drill, tap, or screw perforates or occludes the vertebral artery in the vertebral artery groove of C2, which is located on the lower surface of C2 and lateral to the pedicle ( Fig. 1) [1][2][3][4][5][6][7][8]. It has been suggested that C2 pedicle screw combined with C1 lateral mass screw placement is inherently safer than C1-C2 transarticular screw fixation in view of the risk of vertebral artery injury at C2, as the medially directed trajectory of the C2 pedicle screw carries the screw away from the vertebral artery, which normally is located lateral to the screw [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Risk of vertebral artery injury: comparison between C1–C2 transarticular and C2 pedicle screws

et al. 2013

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BACKGROUND CONTEXT: To our knowledge, no large series comparing the risk of vertebral artery injury by C1-C2 transarticular screw versus C2 pedicle screw have been published. In addition, no comparative studies have been performed on those with a high-riding vertebral artery and/ or a narrow pedicle who are thought to be at higher risk than those with normal anatomy. PURPOSE: To compare the risk of vertebral artery injury by C1-C2 transarticular screw versus C2 pedicle screw in an overall patient population and subsets of patients with a high-riding vertebral artery and a narrow pedicle using computed tomography (CT) scan images and threedimensional (3D) screw trajectory software. STUDY DESIGN: Radiographic analysis using CT scans. PATIENT SAMPLE: Computed tomography scans of 269 consecutive patients, for a total of 538 potential screw insertion sites for each type of screw. OUTCOME MEASURES: Cortical perforation into the vertebral artery groove of C2 by a screw. METHODS:We simulated the placement of 4.0 mm transarticular and pedicle screws using 1-mm-sliced CT scans and 3D screw trajectory software. We then compared the frequency of C2 vertebral artery groove violation by the two different fixation methods. This was done in the overall patient population, in the subset of those with a high-riding vertebral artery (defined as an isthmus height #5 mm or internal height #2 mm on sagittal images) and with a narrow pedicle (defined as a pedicle width #4 mm on axial images). RESULTS: There were 78 high-riding vertebral arteries (14.5%) and 51 narrow pedicles (9.5%). Most (82%) of the narrow pedicles had a concurrent high-riding vertebral artery, whereas only 54% of the high-riding vertebral arteries had a concurrent narrow pedicle. Overall, 9.5% of transarticular and 8.0% of pedicle screws violated the C2 vertebral artery groove without a significant difference between the two types of screws (p5.17). Among those with a high-riding vertebral artery, vertebral artery groove violation was significantly lower (p5.02) with pedicle (49%) than with transarticular (63%) screws. Among those with a narrow pedicle, vertebral artery groove violation was high in both groups (71% with transarticular and 76% with pedicle screws) but without a significant difference between the two groups (p5.55). CONCLUSIONS: Overall, neither technique has more inherent anatomic risk of vertebral artery injury. However, in the presence of a high-riding vertebral artery, placement of a pedicle screw is significantly safer than the placement of a transarticular screw. Narrow pedicles, which might be anticipated to lead to higher risk for a pedicle screw than a transarticular screw, did not result in a significant difference because most patients (82%) with narrow pedicles had a concurrent highriding vertebral artery that also increased the risk with a transarticular screw. Except in case of a high-riding vertebral artery, our results suggest that the surgeon can opt for either technique and expect similar anatomic risks of vertebral artery i...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk of vertebral artery injury: comparison between C1–C2 transarticular and C2 pedicle screws

et al. 2013

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“…27,[54][55][56][57] The main successes with this procedure were improved fusion rates and the end of the absolute need for prolonged post-operative immobilisation. This can partly be attributed to the C1-2 transarticular screw, developed by Magerl, and repeatedly shown to be superior to wire-based fixation systems.…”

Section: Discussionmentioning

confidence: 99%