Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Unilateral Posterior Atlantoaxial Transarticular Screw Fixation in Patients with Atlantoaxial Instability : Comparison with Bilateral Method

  • Hue, Yun-Hee (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Chun, Hyoung-Joon (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Yi, Hyeong-Joong (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Oh, Seong-Hoon (Department of Neurosurgery, Nanoori Hospital) ;
  • Oh, Suck-Jun (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Ko, Yong (Department of Neurosurgery, Hanyang University Medical Center)
  • Published : 2009.03.28
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Abstract

Objective : Bilateral C1-2 transarticular screw fixation (TAF) with interspinous wiring has been the best treatment for atlantoaxial instability (AAI). However, several factors may disturb satisfactory placement of bilateral screws. This study evaluates the usefulness of unilateral TAF when bilateral TAF is not available. Methods : Between January 2003 and December 2007, TAF was performed in 54 patients with AAI. Preoperative studies including cervical x-ray, three dimensional computed tomogram, CT angiogram, and magnetic resonance image were checked. The atlanto-dental interval (ADI) was measured in preoperative period, immediate postoperatively, and postoperative 1, 3 and 6 months. Results : Unilateral TAF was performed in 27 patients (50%). The causes of unilateral TAF were anomalous course of vertebral artery in 20 patients (74%), severe degenerative arthritis in 3 (11%), fracture of C1 in 2, hemangioblastoma in one, and screw malposition in one. The mean ADI in unilateral group was measured as 2.63 mm in immediate postoperatively, 2.61 mm in 1 month, 2.64 mm in 3 months and 2.61 mm in 6 months postoperatively. The mean ADI of bilateral group was also measured as following; 2.76 mm in immediate postoperative, 2.71 mm in 1 month, 2.73 mm in 3 months, 2.73 mm in 6 months postoperatively. Comparison of ADI measurement showed no significant difference in both groups, and moreover fusion rate was 100% in bilateral and 96.3% in unilateral group (p=0.317). Conclusion : Even though bilateral TAF is best option for AAI in biomechanical perspectives, unilateral screw fixation also can be a useful alternative in otherwise dangerous or infeasible cases through bilateral screw placement.

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References

  1. Fuji T, Oda T, Kato Y, Fujita S, Tanaka M : Accuracy of atlantoaxial transarticular screw insertion. Spine 25 : 1760-1764, 2000 https://doi.org/10.1097/00007632-200007150-00004
  2. Gluf WM, Schmidt MH, Apfelbaum RI: Atlantoaxial transarticular screw fixation : a review of surgical indications, fusion rate, complications, and lessons learned in 191 adult patients. J Neurosurg Spine 2 : 155-163, 2005 https://doi.org/10.3171/spi.2005.2.2.0155
  3. Goel A, Desai KI, Muzumdar DP : Atlantoaxial fixation using place and screw method; a report of 160 treated patients. Neurosurgery 51 : 1351-1356; discussion 1356-1357, 2002 https://doi.org/10.1097/00006123-200212000-00004
  4. Hanson P, Montesano P, Sharkey N, Rauschning W : Anatomic and biomechanical assessment of transarticular screw fixation for atlantoaxial instability. Spine 16 : 1141-1145, 1991 https://doi.org/10.1097/00007632-199110000-00002
  5. 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
  6. Hott JS, Lynch JJ, Chamberlain RH, Sonntag VK, Crawford NR : Biomechanical comparison of C1-2 posterior fixation technique. J Neurosurg Spine 2 : 175-181, 2005 https://doi.org/10.3171/spi.2005.2.2.0175
  7. Jun BY : Anatomic study for ideal and safe posterior C1-C2 transarticular screw fixation. Spine 23 : 1703-1707, 1998 https://doi.org/10.1097/00007632-199808010-00018
  8. Lee JH, Jahng TA, Chung CK : C1-2 transarticular screw fixation in high-riding vertebral artery : suggestion of new trajectory. J Spinal Disord Tech 20 : 499-504, 2007 https://doi.org/10.1097/BSD.0b013e318031af51
  9. Marcotte P, Dickman CA, Sonntag VK, Karahalios DG, Drabier J : Posterior atlantoaxial facet screw fixation. J Neurosurg 79 : 234-237, 1993 https://doi.org/10.3171/jns.1993.79.2.0234
  10. Menendez JA, Wright NM : Techniques of posterior C1-C2 stabilization. Neurosurgery 60 : S103-S111, 2007
  11. 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
  12. Neo M, Sakamoto T, Fujibayashi S, Nakamura T : A safe screw trajectory for atlantoaxial transarticular fixation achieved using an aiming device. Spine 30 : E236-E242, 2005 https://doi.org/10.1097/01.brs.0000160998.53282.3f
  13. Neo M, Sakamoto T, Fujibayashi S, Nakamura T : The clinical risk of vertebral artery injury from cervical pedicle screws inserted in degenerative vertebrae. Spine 30 : 2800-2805, 2005 https://doi.org/10.1097/01.brs.0000192297.07709.5d
  14. Nichols LA, Mukherjee DP, Ogden AL, Sadasivan KK, Albrigh JA : A biomechanical study of unilateral posterior atlantoaxial transarticular screw fixation. J Long Term Eff Med Implants 15 : 33-38, 2005 https://doi.org/10.1615/JLongTermEffMedImplants.v15.i1.40
  15. Papagelopoulos PJ, Currier BL, Hokari Y, Neale PG, Zhao C, Berglund LJ, et al : Biomechanical comparison of C1-C2 posterior arthrodesis techniques. Spine 32 : E363-E370, 2007 https://doi.org/10.1097/BRS.0b013e318060cc65
  16. Paramore CG, Dickman CA, Sonntag VK : 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
  17. Prabhu VC, France JC, Voelker JL, Zoarski GH : Vertebral artery pseudoaneurysm complicating posterior C1-2 transarticular screw fixation : case report. Surg Neurol 55 : 29-33; discussion 33-34, 2001 https://doi.org/10.1016/S0090-3019(00)00338-4
  18. Song GS, Theodore N, Dickman CA, Sonntag VK : Unilateral posterior atlantoaxial transarticular screw fixation. J Neurosurg 87 : 851-855, 1997 https://doi.org/10.3171/jns.1997.87.6.0851
  19. Spangenberg P, Coenen V, Gilsbach JM, Rohde V : Virtual placement of posterior C1-C2 transarticular screw fixation. Neurosurg Rev 29 : 114-117, 2006 https://doi.org/10.1007/s10143-005-0003-7
  20. Takahashi J, Shono Y, Nakamura I, Hirabayashi H, Kamimura M, Ebara S, et al : Computer-assisted screw insertion for cervical disorders in rheumatoid arthritis. Eur Spine J 16 : 485-494, 2007 https://doi.org/10.1007/s00586-006-0234-5
  21. 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
  22. 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
  23. 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-E517, 2006 https://doi.org/10.1097/01.brs.0000224516.29747.52

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