Posterior C1-C2 Transarticular Screw Fixation for Atlantoaxial Arthrodesis

Dickman, Curtis A.; Sonntag, Volker K. H.

doi:10.1097/00006123-199808000-00056

Cited by 314 publications

(186 citation statements)

References 27 publications

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“…In order to increase the stability, Magerl and Seeman [8] added transarticular screws through the C1-C2 joints. The good stability achieved by combining transarticular screws with posterior wiring was documented by Grob et al [5], and also led to a higher fusion rate [2].…”

Section: Discussionmentioning

confidence: 85%

The C1 claw device: a new instrument for C1-C2 fusion

Olerud

2001

Eur Spine J

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IntroductionFusion between the C1 and C2 vertebrae due to instability and dislocation has traditionally been performed with the Gallie [4] or the Brooks and Jenkins [1] methods using wire or cable fixation. Both these methods depend on bone blocks put in compression between the C1 arch and the C2 lamina. A new Cl-C2 fixation device, the C1 claw device, has been developed, which establishes a rigid fixation between C1 and C2 without the need for bone blocks in compression. With the introduction of this new claw principle for C1 and C2 fixation, anterior dissection of the C1 arch can be avoided and the grafting can be made with bone chips alone. Both these advantages facilitate the surgery. This new method is of special benefit in cases with defects in the C1 arch, as is illustrated by this case report. The new implantThe implant is made up of two counter-positioned hooks forming a claw that grips the C1 arch firmly. The shaft of the device consists of two semicircular profiles that together make up a 3.5-mm rod. This claw shaft can be connected to a transarticular screw, thus forming a rigid implant that provides both anterior and posterior C1-C2 fixation in a constrained unit (Fig. 1).Abstract A new fixation device for C1-C2 fusion is presented. It consists of a claw construct for the C1 arch that is rigidly attached to C1-C2 transarticular screws to form an instrument that combines anterior and posterior fixation in the same construct. The new device was successfully applied in a case with failed C1-C2 fusion that was initially stabilized with transarticular screws alone, where the usual posterior wiring was omitted due to a defect of the posterior C1 arch.

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Section: Discussionmentioning

confidence: 85%

The C1 claw device: a new instrument for C1-C2 fusion

Olerud

2001

Eur Spine J

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“…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%

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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“…Since then, several different and modified techniques of wiring have been described by other surgeons. 49,113,114 In 2002, Brockmeyer used cable instead of wire for C1-C2 stabilization. In all these techniques, mechanical stability is achieved with structural tricortical iliac bone blocks fixed in compression between C1 and C2 with either wire or cable.…”

Section: Management Of Reducible Atlantoaxial Instability In Oomentioning

confidence: 99%

“…All the nine cases operated by these surgeons indicated OO with RAAD. 114 Later in 2001, Haid et al successfully used this technique in 75 patients. Nine patients out of these 75 reported cases, had congenital anomalies including OO.…”

Section: Management Of Reducible Atlantoaxial Instability In Oomentioning

confidence: 99%

Os Odontoideum: Review Article

Rahimizadeh¹

2017

Orthop Res Traumatol Open J

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Os odontoideum (OO) is defined as an ossicle with circumferential smooth margins and no osseous continuity with the body of axis. While the size of the ossicle is variable, it has a smooth surface, therefore, the cause of this condition has been presumed to be both congenital and traumatic. The possible cause of this condition has been implicated in its underlying etiology. However, patients with this condition may be asymptomatic or may be symptomatic of a variety of neurological deficits and vascular dysfunctions. The treatment of both the asymptomatic and symptomatic characteristics of this condition has undergone changes over the past few decades. The most challenging issue encountered is the management of OO with irreducible atlantoaxial dislocation. This outlines the objective of our discussion to examine the aforementioned subject extensively and review the appropriate potential strategies for the treatment of this condition.

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Posterior C1-C2 Transarticular Screw Fixation for Atlantoaxial Arthrodesis

Cited by 314 publications

References 27 publications

The C1 claw device: a new instrument for C1-C2 fusion

The C1 claw device: a new instrument for C1-C2 fusion

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

Os Odontoideum: Review Article

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