DOI QR코드

DOI QR Code

Inferolateral Entry Point for C2 Pedicle Screw Fixation in High Cervical Lesions

  • Lee, Kwang-Ho (Department of Neurosurgery, Gyeongsang National University School of Medicine) ;
  • Kang, Dong-Ho (Department of Neurosurgery, Gyeongsang National University School of Medicine) ;
  • Lee, Chul-Hee (Department of Neurosurgery, Gyeongsang National University School of Medicine) ;
  • Hwang, Soo-Hyun (Department of Neurosurgery, Gyeongsang National University School of Medicine) ;
  • Park, In-Sung (Department of Neurosurgery, Gyeongsang National University School of Medicine) ;
  • Jung, Jin-Myung (Department of Neurosurgery, Gyeongsang National University School of Medicine)
  • Received : 2011.04.16
  • Accepted : 2011.10.17
  • Published : 2011.10.28

Abstract

Objective : The purpose of this retrospective study was to evaluate the efficacy and safety of atlantoaxial stabilization using a new entry point for C2 pedicle screw fixation. Methods : Data were collected from 44 patients undergoing posterior C1 lateral mass screw and C2 screw fixation. The 20 cases were approached by the Harms entry point, 21 by the inferolateral point, and three by pars screw. The new inferolateral entry point of the C2 pedicle was located about 3-5 mm medial to the lateral border of the C2 lateral mass and 5-7 mm superior to the inferior border of the C2-3 facet joint. The screw was inserted at an angle $30^{\circ}$ to $45^{\circ}$ toward the midline in the transverse plane and $40^{\circ}$ to $50^{\circ}$ cephalad in the sagittal plane. Patients received followed-up with clinical examinations, radiographs and/or CT scans. Results : There were 28 males and 16 females. No neurological deterioration or vertebral artery injuries were observed. Five cases showed malpositioned screws (2.84%), with four of the screws showing cortical breaches of the transverse foramen. There were no clinical consequences for these five patients. One screw in the C1 lateral mass had a medial cortical breach. None of the screws were malpositioned in patients treated using the new entry point. There was a significant relationship between two group (p=0.036). Conclusion : Posterior C1-2 screw fixation can be performed safely using the new inferolateral entry point for C2 pedicle screw fixation for the treatment of high cervical lesions.

Keywords

References

  1. Chen JF, Wu CT, Lee SC, Lee ST : Posterior atlantoaxial transpedicular screw and plate fixation. Technical note. J Neurosurg Spine 2 : 386-392, 2005 https://doi.org/10.3171/spi.2005.2.3.0386
  2. Coyne TJ, Fehlings MG, Wallace MC, Bernstein M, Tator CH : C1-C2 posterior cervical fusion : Long-term evaluation of results and efficacy. Neurosurgery 37 : 688-692; discussion 692-693, 1995 https://doi.org/10.1227/00006123-199510000-00012
  3. Dickman CA, Sonntag VK : Posterior C1-C2 transarticular screw fixation for atlantoaxial arthrodesis. Neurosurgery 43 : 275-280; discussion 280-281, 1998 https://doi.org/10.1097/00006123-199808000-00056
  4. Ebraheim N, Rollins JR Jr, Xu R, Jackson WT : Anatomic consideration of C2 pedicle screw placement. Spine (Phila Pa 1976) 21 : 691-695, 1996 https://doi.org/10.1097/00007632-199603150-00005
  5. Goel A, Desai KI, Muzumdar DP : Atlantoaxial fixation using plate and screw method : a report of 160 treated patients. Neurosurgery 51 : 1351-1356; discussion 1356-1357, 2002 https://doi.org/10.1227/01.NEU.0000309110.78968.F5
  6. Grob D, Crisco JJ 3rd, Panjabi MM, Wang P, Dvorak J : Biomechanical evaluation of four different posterior atlantoaxial fixation techniques. Spine (Phila Pa 1976) 17 : 480-490, 1992 https://doi.org/10.1097/00007632-199205000-00003
  7. Haid RW Jr, Subach BR, McLaughlin MR, Rodts GE Jr, Wahlig JB Jr : C1-C2 transarticular screw fixation for atlantoaxial instability : a 6-year experience. Neurosurgery 49 : 65-68; discussion 69-70, 2001
  8. Hanson PB, Montesano PX, Sharkey NA, Rauschning W : Anatomic and biomechanical assessment of transarticular screw fixation for atlantoaxial instability. Spine (Phila Pa 1976) 16 : 1141-1145, 1991 https://doi.org/10.1097/00007632-199110000-00002
  9. Harms J, Melcher RP : Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976) 26 : 2467-2471, 2001 https://doi.org/10.1097/00007632-200111150-00014
  10. Hoh DJ, Liu CY, Wang MY : A radiographic computed tomography-based study to determine the ideal entry point, trajectory, and length for safe fixation using C-2 pars interarticularis screws. J Neurosurg Spine 12 : 602-612, 2010 https://doi.org/10.3171/2009.12.SPINE09543
  11. Hott JS, Lynch JJ, Chamberlain RH, Sonntag VK, Crawford NR : Biomechanical comparison of C1-2 posterior fixation techniques. J Neurosurg Spine 2 : 175-181, 2005 https://doi.org/10.3171/spi.2005.2.2.0175
  12. Howington JU, Kruse JJ, Awasthi D : Surgical anatomy of the C-2 pedicle. J Neurosurg 95 : 88-92, 2001
  13. 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
  14. 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 https://doi.org/10.1227/01.NEU.0000197222.05299.31
  15. Lehman RA Jr, Dmitriev AE, Helgeson MD, Sasso RC, Kuklo TR, Riew KD : Salvage of C2 pedicle and pars screws using the intralaminar technique : a biomechanical analysis. Spine (Phila Pa 1976) 33 : 960-965, 2008 https://doi.org/10.1097/BRS.0b013e31816c915b
  16. 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
  17. Magerl F : Stable posterior fusion of the atlas and axis by transarticular screw fixation. Cervical Spine 1 : 322-327, 1987
  18. Melcher RP, Puttlitz CM, Kleinstueck FS, Lotz JC, Harms J, Bradford DS : Biomechanical testing of posterior atlantoaxial fixation techniques. Spine (Phila Pa 1976) 27 : 2435-2440, 2002 https://doi.org/10.1097/00007632-200211150-00004
  19. 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
  20. Parker SL, McGirt MJ, Garces-Ambrossi GL, Mehta VA, Sciubba DM, Witham TF, et al. : Translaminar versus pedicle screw fixation of C2 : Comparison of surgical morbidity and accuracy of 313 consecutive screws. Neurosurgery 64 : 343-348; discussion 348-349, 2009
  21. Payer M, Luzi M, Tessitore E : Posterior atlanto-axial fixation with polyaxial C1 lateral mass screws and C2 pars screws. Acta Neurochir (Wien) 151 : 223-229; discussion 229, 2009 https://doi.org/10.1007/s00701-009-0198-4
  22. 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
  23. Resnick DK, Lapsiwala S, Trost GR : Anatomic suitability of the C1-C2 complex for pedicle screw fixation. Spine (Phila Pa 1976) 27 : 1494-1498, 2002 https://doi.org/10.1097/00007632-200207150-00003
  24. Richter M, Schmidt R, Claes L, Puhl W, Wilke HJ : Posterior atlantoaxial fixation : biomechanical in vitro comparison of six different techniques. Spine (Phila Pa 1976) 27 : 1724-1732, 2002 https://doi.org/10.1097/00007632-200208150-00008
  25. Roy-Camille R, Saillant G, Mazel C : Internal fixation of the unstable cervical spine by a posterior osteosynthesis with plates and screws in Sherk HH, Dunn EJ, Eismont FJ (eds) : The Cervical Spine, ed 2. Philadelphia : JB Lippincott, 1989, pp390-403
  26. Sciubba DM, Noggle JC, Vellimana AK, Alosh H, McGirt MJ, Gokaslan ZL, et al. : Radiographic and clinical evaluation of free-hand placement of C-2 pedicle screws. J Neurosurg Spine 11 : 15-22, 2009 https://doi.org/10.3171/2009.3.SPINE08166
  27. Sciubba DM, Noggle JC, Vellimana AK, Conway JE, Kretzer RM, Long DM, et al. : Laminar screw fixation of the axis. J Neurosurg Spine 8 : 327-334, 2008 https://doi.org/10.3171/SPI/2008/8/4/327
  28. Shen FH, Samartzis D, Jenis LG, An HS : Rheumatoid arthritis : evaluation and surgical management of the cervical spine. Spine J 4 : 689-700, 2004 https://doi.org/10.1016/j.spinee.2004.05.001
  29. Smith MD, Anderson P, Grady MS : Occipitocervical arthrodesis using contoured plate fixation. An early report on a versatile fixation technique. Spine (Phila Pa 1976) 18 : 1984-1990, 1993 https://doi.org/10.1097/00007632-199310001-00010
  30. Smith ZA, Bistazzoni S, Onibokun A, Chen NF, Sassi M, Khoo LT : Anatomical considerations for subaxial (C2) pedicle screw placement : a radiographic study with computed tomography in 93 patients. J Spinal Disord Tech 23 : 176-179, 2010 https://doi.org/10.1097/BSD.0b013e3181b40234
  31. Stillerman CB, Wilson JA : Atlanto-axial stabilization with posterior transarticular screw fixation : technical description and report of 22 cases. Neurosurgery 32 : 948-954; discussion 954-955, 1993 https://doi.org/10.1227/00006123-199306000-00011
  32. Wang MY : Cervical crossing laminar screws : early clinical results and complications. Neurosurgery 61 : 311-315; discussion 315-316, 2007 https://doi.org/10.1227/01.neu.0000303987.49870.7b
  33. 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
  34. Yeom JS, Won JH, Park SK, Kwon YJ, Yoo SM, An YH, et al. : The subarticular screw : A new trajectory for the c2 screw. J Korean Soc Spine Surg 13 : 75-80, 2006 https://doi.org/10.4184/jkss.2006.13.2.75
  35. 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 (Phila Pa 1976) 31 : E513-E517, 2006 https://doi.org/10.1097/01.brs.0000224516.29747.52

Cited by

  1. C2 Pars/Pedicle Screws in Management of Craniocervical and Upper Cervical Instability vol.8, pp.2, 2011, https://doi.org/10.4184/asj.2014.8.2.156
  2. Impact of Starting Point and C2 Nerve Status on the Safety and Accuracy of C1 Lateral Mass Screws: Meta-Analysis and Review of the Literature vol.28, pp.5, 2011, https://doi.org/10.1097/bsd.0b013e3182898aa9
  3. Surgical Morphometry of C1 and C2 Vertebrae: A Three-Dimensional Computed Tomography Analysis of 180 Chinese, Indian, and Malay Patients vol.11, pp.2, 2011, https://doi.org/10.4184/asj.2017.11.2.181