The Use of C1 Lateral Mass Screws in Complex Cervical Spine Surgery: Indications, Techniques, and Outcome in a Prospective Consecutive Series of 25 Cases

Gunnarsson, Þorsteinn; Massicotte, Eric M.; Govender, Preneshlin V.; Rampersaud, Y. Raja; Fehlings, Michael G.

doi:10.1097/01.bsd.0000211291.21766.4d

Cited by 79 publications

(60 citation statements)

References 30 publications

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“…Harms construct also has biomechanically superior or at least equivalent stability in comparison with transarticular screw fixation on the all dimensions of motion 4,10,13) . C2 pedicle screw insertion has the lower risk of vertebral artery injury than transarticular screw placement 7,8) . Additionally, C1LM-C2P screw fixation requires smaller incision than transarticular screw fixation due to more vertical trajectory to the axis.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Goel and Laheri 5) have first described a method of C1-C2 fixation using a plate-screw system for the C1LM and C2P as an alternative to transarticular screw fixation in 1994. Furthermore, Harms and Melcher 8) modified Goel's technique using a polyaxial screw-rod construct in 2001 and this approach is widely adopted by many surgeons [7][8][9]11) . C1LM-C2P fixation has advantages over the transarticular screw fixation technique.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Troublesome Occipital Neuralgia Developed by C1-C2 Harms Construct

Rhee

You

Kim

et al. 2008

J Korean Neurosurg Soc

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Troublesome Occipital Neuralgia Developed by C1-C2 Harms Construct

Rhee

You

Kim

et al. 2008

J Korean Neurosurg Soc

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“…In contrast, there is a large body of literature concerning techniques, indications and union rates in C2-fractures [72], but data regarding the most important outcome measure, the functional and clinical outcome, are scant [24,68]. Currently, in addition to nonsurgical treatment including semirigid collars or the Halo-thoracic-vest (HTV), contemporary surgical techniques for the treatment of C2-fractures include anterior odontoid screw fixation (AOSF) [2,62], posterior and anterior transarticular screw fixation C1-2 [51], C1-lateral mass and C2-Isthmus/lamina fixation [32] and plated anterior discectomy and fusion for the unstable Hangman's fracture (Hmfx) [46,83]. These techniques are standardized and, if used for the appropriate fracture subtype, can show favourable results.…”

Section: Introductionmentioning

confidence: 99%

C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes

et al. 2009

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Knowledge on the outcome of C2-fractures is founded on heterogenous samples with cross-sectional outcome assessment focusing on union rates, complications and technical concerns related to surgical treatment. Reproducible clinical and functional outcome assessments are scant. Validated generic and disease specific outcome measures were rarely applied. Therefore, the aim of the current study is to investigate the radiographic, functional and clinical outcome of a patient sample with C2-fractures. Out of a consecutive series of 121 patients with C2 fractures, 44 met strict inclusion criteria and 35 patients with C2-fractures treated either nonsurgically or surgically with motion-preserving techniques were surveyed. Outcome analysis included validated measures (SF-36, NPDI, CSOQ), and a functional CT-scanning protocol for the evaluation of C1-2 rotation and alignment. Mean followup was 64 months and mean age of patients was 52 years. Classification of C2-fractures at injury was performed using a detailed morphological description: 24 patients had odontoid fractures type II or III, 18 patients had fracture patterns involving the vertebral body and 11 included a dislocated or a burst lateral mass fracture. Thirty-one percent of patients were treated with a halo, 34% with a Philadelphia collar and 34% had anterior odontoid screw fixation. At follow-up mean atlantoaxial rotation in left and right head position was 20.2°and 20.6°, respectively. According to the classification system of posttreatment C2-alignment established by our group in part I of the C2-fracture study project, mean malunion score was 2.8 points. In 49% of patients the fractures healed in anatomical shape or with mild malalignment. In 51% fractures healed with moderate or severe malalignment. Self-rated outcome was excellent or good in 65% of patients and moderate or poor in 35%. The raw data of varying nuances allow for comparison in future benchmark studies and metaanalysis. Detailed investigation of C2-fracture morphology, posttreatment C2-alignment and atlantoaxial rotation allowed a unique outcome analysis that focused on the identification of risk factors for poor outcome and the interdependencies of outcome variables that should be addressed in studies on C2-fractures. We recognized that reduced rotation of C1-2 per se was not a concern for the patients. However, patients with worse clinical outcomes had reduced total neck rotation and rotation C1-2. In turn, C2-fractures, especially fractures affecting the lateral mass that healed with atlantoaxial deformity and malunion, had higher incidence of atlantoaxial degeneration and osteoarthritis. Patients with increased severity of C2-malunion and Electronic supplementary material The online version of this article

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“…Harms et al 10) and Goel et al 7) reported 100% bony fusion without VA injury or spinal cord violation using C1LM-C2P screw fixation. Additionally, in a previous paper by Gunnarsson et al 9) , it was reported that C2 pedicle screw insertion had a lower rate of VA injury than TAF.…”

Section: • Acknowledgementsmentioning

confidence: 99%

Targeting a Safe Entry Point for C2 Pedicle Screw Fixation in Patients with Atlantoaxial Instability

Bak

2011

J Korean Neurosurg Soc

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Unless noted otherwise, the procedures are similar to Harm's technique. Under general anesthesia, prone positioning was achieved with a head clamp. Using C-arm guidance, the alignment of the C1-C2 complex was checked. Subperiosteal exposure was performed from the occiput to C4 and the lateral border of the C1-C2 articulation. The venous plexus of the C1-C2 joint was coagulated with bipolar cautery and mechanical compression with a hemostatic agent. Full exposure of the bony structures of the C1-C2 articulation was performed for screw insertion at C1 and C2. For exposure of the entry point of the C1 lateral mass, the ganglion of C2 was retracted in a caudal direction, and the entry point was then marked with a 1 mm high speed burr drill, as in Harm's technique. For C2 pedicle screw fixation, the medial border of the C2 pars interarticularis was carefully exposed to prevent screw malpositioning into the spinal canal. The entry point of C2 was targeted according to the transitional corner, which is the more cephalad portion of the lamina and the C2 isthmus (Fig. 1A, B). Using a high-speed drill, the entry point was marked 4 mm lateral to and 4 mm INTRODUCTIONSeveral methods for stabilization of atlantoaxial instability have been introduced, including the posterior wiring technique (Gallie's 6) and Brook's 1) technique), the interlaminar clamp 25) , transarticular screw fixation (TAF) 16) , and C1 lateral mass-C2 pedicle (C1LM-C2P) screw fixation. 10) Among them, the C1LM-C2P technique has recently gained popularity due to several advantages, including less vertebral artery injury, greater fixation strength, intraoperative reduction, the ability to perform laminectomy concurrently, and a high fusion rate. However, surgeons should pay close attention to C2 pedicle screw fixation to prevent vertebral artery (VA) injury. In the present study, the authors describe a new, safe entry targeting method for C2 pedicle screw fixation. Department of Neurosurgery, Hanyang University Medical Center, Seoul, KoreaObjective : This investigation was conducted to evaluate a new, safe entry point for the C2 pedicle screw, determined using the anatomical landmarks of the C2 lateral mass, the lamina, and the isthmus of the pars interarticularis. Methods : Fifteen patients underwent bilateral C1 lateral mass-C2 pedicle screw fixation, combined with posterior wiring. The C2 pedicle screw was inserted at the entry point determined using the following method : 4 mm lateral to and 4 mm inferior to the transitional point (from the superior end line of the lamina to the isthmus of the pars interarticularis). After a small hole was made with a high-speed drill, the taper was inserted with a 30 degree convergence in the cephalad direction. Other surgical procedures were performed according to Harm's description. Preoperatively, careful evaluation was performed with a cervical X-ray for C1-C2 alignment, magnetic resonance imaging for spinal cord and ligamentous structures, and a contrast-enhanced 3-dimensional computed tomogram (3-D CT) for bony...

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The Use of C1 Lateral Mass Screws in Complex Cervical Spine Surgery: Indications, Techniques, and Outcome in a Prospective Consecutive Series of 25 Cases

Cited by 79 publications

References 30 publications

Troublesome Occipital Neuralgia Developed by C1-C2 Harms Construct

Troublesome Occipital Neuralgia Developed by C1-C2 Harms Construct

C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes

Targeting a Safe Entry Point for C2 Pedicle Screw Fixation in Patients with Atlantoaxial Instability

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