Anatomic Considerations of Anterior Transarticular Screw Fixation for Atlantoaxial Instability

Sonone, Sandeep; Dahapute, Aditya Anand; Waghchoure, Chaitanya; Marathe, Nandan; Keny, Swapnil Anil; Singh, Kritarth; Gala, Rohan

doi:10.31616/asj.2019.0006

Cited by 11 publications

(8 citation statements)

References 14 publications

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“…Methods to study the anatomical and morphological features of the atlantoaxial spine have been developing and advancing, and Lu et al [ 14 ] used calipers and a goniometer to measure bony specimens to determine the length, width, and inclination angle of the upper and lower articular surfaces of the lateral mass joint to provide data to support the placement of anterior transarticular screws. Dong and Rocha et al [ 15 – 17 ] measured the mean thickness, width, height and coronal inclination of the lateral mass joint using cadavers and found a relatively low incidence of atlantoaxial articular cartilage degeneration.…”

Section: Discussionmentioning

confidence: 99%

Study on articular surface morphology of atlantoaxial lateral mass based on differential manifold

Zhang,

Zhao,

Chou

et al. 2023

J Orthop Surg Res

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Objectives To propose a surface reconstruction algorithm based on a differential manifold (a space with local Euclidean space properties), which can be used for processing of clinical images and for modeling of the atlantoaxial joint. To describe the ideal anatomy of the lateral atlantoaxial articular surface by measuring the anatomical data. Methods Computed tomography data of 80 healthy subjects who underwent cervical spine examinations at our institution were collected between October 2019 and June 2022, including 46 males and 34 females, aged 37.8 ± 5.1 years (28–59 years). A differential manifold surface reconstruction algorithm was used to generate the model based on DICOM data derived by Vision PACS system. The lateral mass articular surface was measured and compared in terms of its sagittal diameter, transverse diameter, articular surface area, articular curvature and joint space height. Results There was no statistically significant difference between left and right sides of the measured data in normal adults (P > 0.05). The atlantoaxial articular surface sagittal diameter length was (15.83 ± 1.85) and (16.22 ± 1.57) mm on average, respectively. The transverse diameter length of the articular surface was (16.29 ± 2.16) and (16.49 ± 1.84) mm. The lateral articular surface area was (166.53 ± 7.69) and (174.48 ± 6.73) mm2 and the curvature was (164.03 ± 5.27) and (153.23 ± 9.03)°, respectively. The joint space height was 3.05 ± 0.11mm, respectively. There is an irregular articular space in the lateral mass of atlantoaxial, and both upper and lower surfaces of the articular space are concave. A sagittal plane view shows that the inferior articular surface of the atlas is mainly concave above; however, the superior articular surface of the axis is mainly convex above. In the coronal plane, the inferior articular surface of the atlas is mostly concave above, with most concave vertices located in the medial region, and the superior articular surface of the axis is mainly concave below, with most convex vertices located centrally and laterally. Conclusion A differential manifold algorithm can effectively process atlantoaxial imaging data, fit and control mesh topology, and reconstruct curved surfaces to meet clinical measurement applications with high accuracy and efficiency; the articular surface of the lateral mass of atlantoaxial mass in normal adults has relatively constant sagittal diameter, transverse diameter and area. The distance difference between joint spaces is small, but the shape difference of articular surfaces differs greatly.

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Section: Discussionmentioning

confidence: 99%

Study on articular surface morphology of atlantoaxial lateral mass based on differential manifold

Zhang,

Zhao,

Chou

et al. 2023

J Orthop Surg Res

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“…Several reports indicate that the pedicle perforation rate ranges between 6.7% and 30%. [23][24][25][26] Additionally, Uehara et al reported that the rate of cervical pedicle screw perforation among CP patients, was higher than that of other conditions such as rheumatoid arthritis or degenerative spondyloarthropathy. 27 For CP-CM patients, the A-P construct could correct kypho-scoliotic deformities effectively and safely via proper restoration of the intervertebral height.…”

Section: Discussionmentioning

confidence: 99%

Combined Anterior-Posterior Fusion Versus Posterior Alone Fusion for Cervical Myelopathy in Athetoid-Cerebral Palsy

Kim

Ahn

Lee

2021

Global Spine Journal

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Study Design: Retrospective comparative study. Objectives: Although some studies have discussed the use of lateral mass screws (LMSs) in patients with cerebral palsy (CP), it is unclear whether posterior LMS fixation alone is a suitable method. We aimed to compare the clinical, radiological, and surgical outcomes of 2 surgical modalities, namely, combined anterior-posterior (A-P) instrumented fusion and posterior fusion alone, in athetoid-type CP patients with cervical myelopathy (CM). Methods: We analyzed 63 patients with athetoid-CP and CM who underwent posterior fusion only with LMS (group A, 35 patients) and A-P fusion (group B, 28 patients). The primary outcome was the 1- and 3-year fusion rates for the surgical segments. The secondary outcomes included the clinical outcomes based on pain intensity determined using the visual analog scale score, neck disability index, and 17-point Japanese Orthopedic Association score, radiological, and surgical outcomes. Results: Fusion was achieved at 3 years postoperatively in 22 of 35 patients (63%) in group A and in 26 of 28 patients (93%) in group B ( P = 0.02). The posterior neck pain intensity was also significantly lower in group B than in group A 2 and 3 years postoperatively ( P = 0.02 and 0.01, respectively). The incidence of screw loosening and implant-related problems was higher in group A (60%) than in group B (21%) ( P = 0.01). The other clinical and radiological parameters were similar between the groups. Conclusions: For athetoid CP-induced CM, combined A-P fusion would result in superior clinical and radiological outcomes compared to posterior fusion alone.

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“…The screw must be inserted with lateral angulation, and the maximum angles of the lateral and posterior angulations are 26° and 30°. This study provided vital information for surgeons to avoid injuries of the vertebral artery and violations of the spinal canal or atlanto-occipital joint (26). The feasibility of the use of anterior transarticular crossing screws (ATCSs) was con rmed in the cadaveric specimen, and this method has been used in clinics.…”

Section: Discussionmentioning

confidence: 99%

Comparison of two techniques for the treatment for atlantoaxial instability injury: C1–C2 transarticular screws and C1 lateral mass–C2 pedicle screws

Du¹,

Thanh²,

Phuoc³

et al. 2020

Preprint

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Abstract Background: The aim was to evaluate the effectiveness and safety of transarticular C1–C2 screw fixation (C1C2-TAS) and C1 lateral mass–C2 pedicle screw fixation (C1LM-C2PS) in patients with C1–C2 instability injuries.Methods: This study was a prospective, self-controlled, single-institute study on two fixation techniques for the treatment of atlantoaxial instability caused by injury. From 06/2006 to 02/2017, 118 patients were allocated into two groups: group 1 (C1C2-TAS group) with 52 patients and group 2 (C1LM-C2PS group) with 66 patients. The investigated variables were noted before, during and after surgery. All patients were closely followed up through physical examination and radiological imaging at 3 months postoperatively.Results: There were significant differences in operation time, blood loss, and hospital length-stay between the two groups (p <0.001). Compared with those in the C1LM-C2PS group, the mean operation time was shorter (78.94 vs. 110.91 min; p = 0.0003), blood loss during surgery was lower (122.31 vs. 258.33 ml; p <0.0001) and hospital length-stay was shorter (5.31 vs. 8.34 days; p = 0.0003) in the C1C2–TAS group. The complication of surgery was low with no injury of vertebral artery. After surgery, clinical presentations were significantly reduced and were statistically significant in both groups. The remaining patients showed satisfactory internal fixation in the postoperative radiographs and CT examination.Conclusion: C1C2-TAS and C1LM-C2PS demonstrated effectiveness and safety in the treatment of patients with atlantoaxial instability injury. Notably, C1C2-TAS resulted in shorter surgical time, lower blood loss during surgery and shorter in-hospital stay than C1LM-C2PS.

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Anatomic Considerations of Anterior Transarticular Screw Fixation for Atlantoaxial Instability

Cited by 11 publications

References 14 publications

Study on articular surface morphology of atlantoaxial lateral mass based on differential manifold

Study on articular surface morphology of atlantoaxial lateral mass based on differential manifold

Combined Anterior-Posterior Fusion Versus Posterior Alone Fusion for Cervical Myelopathy in Athetoid-Cerebral Palsy

Comparison of two techniques for the treatment for atlantoaxial instability injury: C1–C2 transarticular screws and C1 lateral mass–C2 pedicle screws

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