Modified Trajectory of C2 Laminar Screw-Double Bicortical Purchase of the Inferiorly Crossing Screw

  • Rhee, Woo-Tack (Department of Neurosurgery Gangneung Asan Hospital College of Medicine Ulsan University) ;
  • You, Seung-Hoon (Department of Neurosurgery Gangneung Asan Hospital College of Medicine Ulsan University) ;
  • Jang, Yeon-Gyu (Department of Neurosurgery Gangneung Asan Hospital College of Medicine Ulsan University) ;
  • Lee, Sang-Youl (Department of Neurosurgery Gangneung Asan Hospital College of Medicine Ulsan University)
  • Published : 2008.02.29

Abstract

The crossing laminar screw fixation might be the most recently developed approach among various fixation techniques for C2. The new construct has stability comparable to transarticular or transpedicular screw fixation without risk of vertebral artery injury. Quantitative anatomical studies about C2 vertebra suggest significant variation in the thickness of C2 lamina as well as cross sectional area of junction of lamina and spinous process. We present an elderly patient who underwent an occipito-cervical stabilization incorporating crossed C2 laminar screw fixation. We preoperatively recognized that she had low profiles of C2 lamina, and thus made a modification of trajectory for the inferiorly crossing screw. We introduce a simple modification of crossing C2 laminar screw technique to improve stability in patients with low laminar profiles.

Keywords

References

  1. 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
  2. Cassinelli EH, Lee M, Skalak Anthony, Ahn NU, Wright NM : Anatomic considerations for the placement of C2 laminar screws. Spine 31 : 2767-2771, 2006 https://doi.org/10.1097/01.brs.0000245869.85276.f4
  3. Hong JT, Lee SW, Son BC, Park CK : Posterior C1-2 stabilization using translaminar screw fixation of the axis. J Korean Neurosurg Soc 40 : 387-390, 2006
  4. Jea A, Sheth RN, Vanni S, Green BA, Levi AD : Modification of Wright's technique for placement of bilateral crossing C2 translaminar screws : technical note. Spine J : in press, 2007
  5. Kim SY, Jang JS, Lee SH : Posterior atlantoaxial fixation with a combination of pedicle screws and a laminar screw in the axis for a unilateral high-riding vertebral artery. J Korean Neurosurg Soc 41 : 141-144, 2007
  6. Madawi A, Casey A, Solanki G, Tuite G, Veres R, Crockard H : 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
  7. Paramore C, Dickman C, Sonntag VKH : The anatomical suitability of the C1-2 complex for transarticular screw fixation. J Neurosurg 85 : 221-224, 1996 https://doi.org/10.3171/jns.1996.85.2.0221
  8. Reddy C, Ingalhalikar AV, Channon S, Lim TH, Torner J, Hitchon PW : In vitro biomechanical comparison of transpedicular versus translaminar C-2 screw fixation in C2-3 instrumentation. J Neurosurg Spine 7 : 414-418, 2007 https://doi.org/10.3171/SPI-07/10/414
  9. Reilly TM, Sasso RC, Hall PV : Atlantoaxial stabilization : clinical comparison of posterior cervical wiring technique with transarticular screw fixation. J Spinal Disord Tech 16 : 248-253, 2003 https://doi.org/10.1097/00024720-200306000-00004
  10. Wang MY : C2 crossing laminar screws : cadaveric morphometric analysis. Neurosurgery 59 (1 Suppl 1) : ONS84-88, 2006
  11. Wright NM : Posterior C2 fixation using bilateral, crossing C2 laminar screws : case series and technical note. J Spinal Disorder Tech 17 : 158-162, 2004 https://doi.org/10.1097/00024720-200404000-00014
  12. Wright NM, Lauryssen C : Vertebral artery injury in C1-2 transarticular screw fixation : results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves. American association of neurological surgeons/congress of neurological surgeons. J Neurosurg 88 : 634-640, 1998 https://doi.org/10.3171/jns.1998.88.4.0634
  13. Xu R, Burgar A, Ebraheim N, Yeasting R : The quantitative anatomy of the laminas of the spine. Spine 24 : 107-113, 1999 https://doi.org/10.1097/00007632-199901150-00002