Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지

Posterior Atlantoaxial Fixation with a Combination of Pedicle Screws and a Laminar Screw in the Axis for a Unilateral High-riding Vertebral Artery

  • Kim, Sei-Yoon (Department of Neurosurgery, Gimpo Airport Wooridul Spine Hospital) ;
  • Jang, Jee-Soo (Department of Neurosurgery, Gimpo Airport Wooridul Spine Hospital) ;
  • Lee, Sang-Ho (Department of Neurosurgery, Gimpo Airport Wooridul Spine Hospital)
  • Published : 2007.02.28
Download PDF
⟨ Previous Next ⟩

Abstract

A vertebral arte [VA] injury presents a difficult problem in atlantoaxial fixation. Recent technical reports described posterior C2 fixation using bilateral, crossing C2 laminar screws. The translaminar screw technique has the advantages of producing little risk of VA injury and the unconstrained screw placement. In addition, biomechanical studies have demonstrated the potential of the translaminar screw technique to provide a firmer construct that is equivalent to methods currently used. We report the successful treatment of C1-2 instability with a left-side high-riding VA. Because of the potential risk of VA injury, we performed a posterior C1-2 fixation with a combination of pedicle screws and a laminar screw in C2. We first placed bilateral C1 lateral mass screws and a right-side C2 pedicle screw. However, placement of the left- side C2 pedicle screw was technically difficult due to a narrow isthmus and pedicle. A laminar screw was inserted instead and authors believe that this posterior C1-C2 fixation with a combination of pedicle screws and a laminar screw in C2 can be a useful alternative technique for the treatment of C1-C2 instability in the presence of a unilateral high-riding VA.

Keywords

References

  1. Bloch O, Holly LT, Park J, Obasi C, Kim K, Johnson JP : Effect of frameless stereotaxy on the accuracy of C1-2 transarticular screw placement. J Neurosurg 95 : 74-79, 2001 https://doi.org/10.3171/jns.2001.95.1.0001
  2. Brooks AL, Jenkins EB : Atlanto-axial arthrodesis by the wedge compression method. J Bone Joint Surg Am 60 : 279-284, 1978 https://doi.org/10.2106/00004623-197860030-00001
  3. Dickman CA, Sonntag VK, Papadopoulos SM, Hadley MN : The interspinous method of posterior atlantoaxial arthrodesis. J Neurosurg 74 :190-198, 1991 https://doi.org/10.3171/jns.1991.74.2.0190
  4. Ebraheim N, Rollins JR Jr, Xu R, Jackson WT : Anatomic consideration of C2 pedicle screw placement. Spine 21 : 691-695, 1996 https://doi.org/10.1097/00007632-199603150-00005
  5. Goel A : C1-C2 pedicle screw fixation with rigid cantilever beam construct : case report and technical note. Neurosurgery 51 : 853-854; author reply 854, 2002 https://doi.org/10.1097/00006123-200209000-00058
  6. Goel A, Gupta S : Vertebral artery injury with transarticular screws. J Neurosurg 90 : 376-377, 1999
  7. Gorek J, Acaroglu E, Berven S, Yousef A, Puttlitz CM : Constructs incorporating intralaminar C2 screws provide rigid stability for atlantoaxial fixation. Spine 30 : 1513-1518, 2005 https://doi.org/10.1097/01.brs.0000167827.84020.49
  8. Grob D, Crisco JJ 3rd, Panjabi MM, Wang P, Dvorak J : Biomechanical evaluation of four different posterior atlantoaxial fixation techniques. Spine 17 : 480-490, 1992 https://doi.org/10.1097/00007632-199205000-00003
  9. Harms J, Melcher RP : Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine 26 : 2467-2471, 2001 https://doi.org/10.1097/00007632-200111150-00014
  10. Jeanneret B, Magerl F : Primary posterior fusion C1/2 in odontoid fractures : indications, technique, and results of transarticular screw fixation. J Spinal Disord 5 : 464-475, 1992 https://doi.org/10.1097/00002517-199212000-00012
  11. Lapsiwala SB, Anderson PA, Oza A, Resnick DK : Biomechanical comparison of four C1 to C2 rigid fixative techniques: anterior transarticular, posterior transarticular, C1 to C2 pedicle, and C1 to C2 intralaminar screws. Neurosurgery 58 : 516-521; discussion 516-521, 2006
  12. Lee DY, Chung CK, Jahng TA : Atlantoaxial fixation using rod and screw for bilateral high-riding vertebral artery. J Korean Neurosurg Soc 37 : 380-382, 2005
  13. Leonard JR, Wright NM : Pediatric atlantoaxial fixation with bilateral, crossing C-2 translaminar screws. Technical note. J Neurosurg 104 : 59-63, 2006
  14. Madawi AA, Casey AT, Solanki GA, Tuite G, Veres R, Crockard HA : Radiological and anatomical evaluation of the atlantoaxial transarticular screw fixation technique. J Neurosurg 86 : 961-968, 1997 https://doi.org/10.3171/jns.1997.86.6.0961
  15. Neo M, Matsushita M, Iwashita Y, Yasuda T, Sakamoto T, Nakamura T : Atlantoaxial transarticular screw fixation for a high-riding vertebral artery. Spine 28 : 666-670, 2003 https://doi.org/10.1097/00007632-200304010-00009
  16. Neo M, Matsushita M, Yasuda T, Sakamoto T, Nakamura T : Use of an aiming device in posterior atlantoaxial transarticular screw fixation. Technical note. J Neurosurg 97 : 123-127, 2002
  17. Resnick DK, Benzel EC : C1-C2 pedicle screw fixation with rigid cantilever beam construct : case report and technical note. Neurosurgery 50 : 426-428, 2002 https://doi.org/10.1097/00006123-200202000-00039
  18. Shin DA, Kim KN, Yoon DH : Posterior atlantoaxial fixation with lateral mass screw in the atlas and pedicle screw in the axis. J Korean Neurosurg Soc 34 : 491-494, 2003
  19. Weidner A, Wahler M, Chiu ST, Ullrich CG : Modification of C1-C2 transarticular screw fixation by image-guided surgery. Spine 25 : 2668-2673; discussion 2674, 2000 https://doi.org/10.1097/00007632-200010150-00020
  20. Wright NM : Posterior C2 fixation using bilateral, crossing C2 laminar screws : case series and technical note. J Spinal Disord Tech 17 : 158-162, 2004 https://doi.org/10.1097/00024720-200404000-00014
  21. Yoshida M, Neo M, Fujibayashi S, Nakamura T : Comparison of the anatomical risk for vertebral artery injury associated with the C2-pedicle screw and atlantoaxial transarticular screw. Spine 31 : E513-517, 2006 https://doi.org/10.1097/01.brs.0000224516.29747.52