Posterior atlantoaxial fixation: a review of all techniques

Huang, Dageng; Hao, Dingjun; He, Baorong; Wu, Qin; Liu, Tuan-Jiang; Wang, Xiaodong; Guo, Hua; Fang, Xiangyi

doi:10.1016/j.spinee.2015.07.008

Cited by 107 publications

(84 citation statements)

References 79 publications

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“…mechanical stability; 12,13,229 however, they suffer from an increased risk of vertebral artery injury compared with ventral stabilization techniques. Previous studies have reported a vertebral artery injury rate ranging from 0% to 8.2% 24,36 in clinical studies and up to 26% in cadaveric studies.…”

mentioning

confidence: 99%

Spinal navigation for posterior instrumentation of C1–2 instability using a mobile intraoperative CT scanner

Czabanka¹,

Haemmerli²,

Hecht³

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVESpinal navigation techniques for surgical fixation of unstable C1–2 pathologies are challenged by complex osseous and neurovascular anatomy, instability of the pathology, and unreliable preoperative registration techniques. An intraoperative CT scanner with autoregistration of C-1 and C-2 promises sufficient accuracy of spinal navigation without the need for further registration procedures. The aim of this study was to analyze the accuracy and reliability of posterior C1–2 fixation using intraoperative mobile CT scanner–guided navigation.METHODSIn the period from July 2014 to February 2016, 10 consecutive patients with instability of C1–2 underwent posterior fixation using C-2 pedicle screws and C-1 lateral mass screws, and 2 patients underwent posterior fixation from C-1 to C-3. Spinal navigation was performed using intraoperative mobile CT. Following navigated screw insertion in C-1 and C-2, intraoperative CT was repeated to check for the accuracy of screw placement. In this study, the accuracy of screw positioning was retrospectively analyzed and graded by an independent observer.RESULTSThe authors retrospectively analyzed the records of 10 females and 2 males, with a mean age of 80.7 ± 4.95 years (range 42–90 years). Unstable pathologies, which were verified by fracture dislocation or by flexion/extension radiographs, included 8 Anderson Type II fractures, 1 unstable Anderson Type III fracture, 1 hangman fracture Levine Effendi Ia, 1 complex hangman-Anderson Type III fracture, and 1 destructive rheumatoid arthritis of C1–2. In 4 patients, critical anatomy was observed: high-riding vertebral artery (3 patients) and arthritis-induced partial osseous destruction of the C-1 lateral mass (1 patient). A total of 48 navigated screws were placed. Correct screw positioning was observed in 47 screws (97.9%). Minor pedicle breach was observed in 1 screw (2.1%). No screw displacement occurred (accuracy rate 97.9%).CONCLUSIONSpinal navigation using intraoperative mobile CT scanning was reliable and safe for posterior fixation in unstable C1–2 pathologies with high accuracy in this patient series.

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mentioning

confidence: 99%

Spinal navigation for posterior instrumentation of C1–2 instability using a mobile intraoperative CT scanner

Czabanka¹,

Haemmerli²,

Hecht³

et al. 2017

Journal of Neurosurgery: Spine

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show abstract

“…[36–39] Thus, the C1 pedicle screw combined with C2 pedicle screw fixation, first described by Resnick and Benzel in 2002, [40] has become the most popular fixation technique. [11] …”

Section: Discussionmentioning

confidence: 99%

“…[7–10] Thus, C1–C2 transpedicular screw fixation has become a popular fixation technique among the posterior atlantoaxial fixation techniques. [11,12] However, the complex anatomical structure of this region ascribes the implantation of pedicle screw as a technique with the high requirement and risk, necessitating an exact 3-dimensional understanding obligatory for a successful screw insertion. The ideal entry point should be at the center of C1 “pedicle”; however, the current free-hand techniques cannot assist the surgeon in an intuitive determination of its precise location.…”

Section: Introductionmentioning

confidence: 99%

“Direct vision” operation of posterior atlantoaxial transpedicular screw fixation for unstable atlantoaxial fractures

Cao

Yang

et al. 2017

Medicine

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“…AAI may originate from conginal conditions, but in adults, it primarily originates from trauma or degenerative changes due to inflammatory disease such as rheumatoid arthritis [2]. Approaches used to treat AAI include posterior atlantoaxial fixation, which has been deemed to be an effective method to treat AAI [3]. In recent years, many types of posterior screw fixation techniques for AAI for treatment have been introduced, such as bilateral C1 lateral mass and C2 pedicle screw fixation, posterior C1–2 transarticular screw fixation and posterior atlantoaxial pedicle screw fixation [4–6].…”

Section: Introductionmentioning

confidence: 99%

Computed tomographic morphometric analysis of lateral inclination C1 pedicle screw for atlantoaxial instability patients with a narrow C1 posterior arch

Zhang

Wang

2018

The Kaohsiung J of Med Scie

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Atlanto‐axial instability (AAI) is a congenital or developmental condition that leads to instability/subluxation of the atlantoaxial joint. This study is performed to determine anatomic feasibility of trajectory L and help select an optimal screw trajectory in treating patients with AAI with a narrow C1 posterior arch. Sixty patients who underwent cervical three dimensional‐computed tomography (3D‐CT) were chosen from the hospital's picture archiving and communication system (PACS). Aquilion Multi 64 helical CT was used to perform CT examinations and measurements on patients. Based on CT images, the trajectory L and M for each C1 pedicle were established. Posterior arch height was measured on C1 coronal image. The medullary cavity width along trajectory M was narrower than trajectory L. The medullary cavity width that was less than 3.5 mm was found in 12.5% pedicles along trajectory M and 2.5% along trajectory L. The posterior arch height along trajectory L was significantly higher than that of trajectory M. Posterior arch height that was less than 3.5 mm was found in 74.2% pedicles along trajectory M and only 16.7% along trajectory L. The pedicle length along trajectory L was significantly longer than trajectory M. Trajectory angles for C1 pedicles had an average of 9.08° ± 4.66° along trajectory L and 14.53° ± 4.03° along trajectory M. The Optimal entry point of trajectory L was 5.4 mm medial to trajectory M. Based on our results, this study suggests that C1 pedicle screw trajectory with lateral inclination yielded a good outcome in the treatment of AAI.

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Posterior atlantoaxial fixation: a review of all techniques

Cited by 107 publications

References 79 publications

Spinal navigation for posterior instrumentation of C1–2 instability using a mobile intraoperative CT scanner

Spinal navigation for posterior instrumentation of C1–2 instability using a mobile intraoperative CT scanner

“Direct vision” operation of posterior atlantoaxial transpedicular screw fixation for unstable atlantoaxial fractures

Computed tomographic morphometric analysis of lateral inclination C1 pedicle screw for atlantoaxial instability patients with a narrow C1 posterior arch

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