Posterior atlantoaxial transpedicular screw and plate fixation

Abstract

<jats:p content-type="fine-print">✓ The authors describe a modified posterior atlantoaxial fixation technique for the treatment of reducible atlantoaxial instability, which can be performed simply and easily, and can decrease the risk of vessel and/or neural damage.</jats:p> <jats:p content-type="fine-print">During an 18-month period, this technique was undertaken in 11 patients with atlantoaxial instability. There was no procedure-related morbidity. The follow-up period ranged from 8 to 18 months (mean 13.2 months). Fusion was documented in all 11 patients, and there was no progression of spinal deformity.</jats:p> <jats:p content-type="fine-print">This technique can be considered an effective alternative in the treatment of atlantoaxial subluxation.</jats:p>

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

“…This is contrary to the previous suggestions [9][10][11] that pedicle screws are more likely to avoid injuring the vertebral artery because the artery is located lateral to the screw and the screw is placed medialward, as shown in Fig. 3.…”

“…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.…”

“…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. Whereas some surgeons [9][10][11] have suggested that C2 pedicle screws have theoretical advantages over C1-C2 transarticular screws, as far as vertebral artery injury is concerned, the only two studies comparing the two fixation methods [12,13] have concluded that the risk is not significantly different. Resnick et al [13] compared the risk with 4.0 mm transarticular screws versus pedicle screws using CT scans.…”

“…Both studies stated that the anatomic risk of vertebral artery injury is not significantly different between transarticular and pedicle screws, contrary to the previous suggestion favoring pedicle screw [9][10][11]. Although these studies carefully analyzed the risk of each fixation method, like all studies, they have limitations.…”

“…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]. Although this is a commonly held belief, no large series have been performed to assess the validity of this assumption.…”