Anterior retropharyngeal fixation C1-2 for stabilization of atlantoaxial instabilities: study of feasibility, technical description and preliminary results

Koller, Heiko; Kammermeier, Volker; Ulbricht, D.; Assuncao, Allan; Karolus, Stefan; Berg, Boris van den; Holz, U.

doi:10.1007/s00586-006-0103-2

Cited by 63 publications

(50 citation statements)

References 44 publications

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“…The majority of anatomical in vivo dimensions investigated in the current study have not been studied previously as a whole, any isolated dimensions in ex vivo studies, or used in the comparison of differing measuring techniques [11,41,65]. The authors are not aware of any study that included interobserver calculations for the purpose of assessing the reproducibility of the C2 measurements performed.…”

Section: Discussionmentioning

confidence: 99%

“…However, differences in functional and clinical outcomes related to the posttreatment C2-alignment have not been studied. In this context, it is noteworthy that some of the painful C2-malunions indicate secondary anterior or posterior C1-2 fusion [20,41,62,68]. Malunion in C2-fractures can produce significant sequelae and those subtypes of C2-fractures that are prone to malunion with nonsurgical therapy or motion-preserving surgery should be defined and a further stratification performed.…”

Section: Discussionmentioning

confidence: 99%

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C2-fractures: part I. Quantitative morphology of the C2 vertebra is a prerequisite for the radiographic assessment of posttraumatic C2-alignment and the investigation of clinical outcomes

et al. 2009

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Pertinent literature exists concerning indications, techniques, complications of treatment, and risk factors for nonunion in axis and odontoid fractures; however, there are scarce data regarding the incidence and definition of malunion in these fractures. As a prerequisite for the study of anatomical alignment following surgical and nonsurgical treatment of C2-fractures, an understanding of normal C2 anatomy is essential. Therefore, the authors intended to evaluate morphometrical dimensions of the C2 vertebra. The purpose was to provide normalized quantitative data to enable assessment of malalignment following the treatment of C2-fractures within a classification system. Using digitized cervical spine lateral and transoral odontoid radiographs of 100 consecutive patients without any evidence of traumatic or neoplastic disorders, the authors performed measurements on distinct anatomical structures and investigated morphometrical dimensions of the normal axis vertebra. The incidence of atlantoaxial arthritis was also evaluated. In addition, with the assessment of twenty arbitrarily chosen sets of radiographs by three different observers we calculated the interobserver reliability in terms of intraclass correlation coefficients for each parameter. With calculation of SD and 95% confidence limits, pathological cut-offs were reconstructed from measurements performed resembling non-physiological and pathological limits. Distinct parameters were selected to form a new classification system for radiographical follow-up that focuses on the quantitative C1-2 vertebral alignment. The measurement process resulted in 2,400 data points. Distinct morphometrical parameters, such as a quantitative characterization of the sagittal atlantoaxial congruency, the lateral mass inclination and the type of degenerative changes at the atlantoaxial joint could be demonstrated to be valuable and reliably used within a proposed classification for C2-malunions following C2-fractures. The current study offers a template including recommended radiological measurements for further research on the study of clinical outcome and posttraumatic alignment following C2-fractures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

C2-fractures: part I. Quantitative morphology of the C2 vertebra is a prerequisite for the radiographic assessment of posttraumatic C2-alignment and the investigation of clinical outcomes

et al. 2009

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“…A meaningful number of subtypes of C2-fractures exists where complete reduction, normal C1-2 rotation and a physiological anatomy is difficult to restore [1,10,11,34,42,43,71,82]. Likewise, a non-anatomical posttreatment C2-alignment, resembling a malunion, can cause significant symptoms even indicating fusion C1-2 [13,26,30,42,47,51,52,67,70,71,78,79] as it had to be done in one of our cases (Fig. 3), two others being scheduled (Fig.…”

Section: Malunion Of C2mentioning

confidence: 88%

“…Even though the osseus contour of the lateral C1-2 joints looks concave on radiographs, the padding of joint cartilage converts the articulating surfaces to biconvex discs [58] with the cartilage cover averaging 1.5-2 mm [48,51]. The spaces anterior and posterior where the articular surfaces diverge are filled by intra-articular meniscoids [48].…”

Section: Functional Outcome and Atlantoaxial Rotationmentioning

confidence: 99%

“…In contrast, there is a large body of literature concerning techniques, indications and union rates in C2-fractures [72], but data regarding the most important outcome measure, the functional and clinical outcome, are scant [24,68]. Currently, in addition to nonsurgical treatment including semirigid collars or the Halo-thoracic-vest (HTV), contemporary surgical techniques for the treatment of C2-fractures include anterior odontoid screw fixation (AOSF) [2,62], posterior and anterior transarticular screw fixation C1-2 [51], C1-lateral mass and C2-Isthmus/lamina fixation [32] and plated anterior discectomy and fusion for the unstable Hangman's fracture (Hmfx) [46,83]. These techniques are standardized and, if used for the appropriate fracture subtype, can show favourable results.…”

Section: Introductionmentioning

confidence: 99%

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C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes

et al. 2009

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Knowledge on the outcome of C2-fractures is founded on heterogenous samples with cross-sectional outcome assessment focusing on union rates, complications and technical concerns related to surgical treatment. Reproducible clinical and functional outcome assessments are scant. Validated generic and disease specific outcome measures were rarely applied. Therefore, the aim of the current study is to investigate the radiographic, functional and clinical outcome of a patient sample with C2-fractures. Out of a consecutive series of 121 patients with C2 fractures, 44 met strict inclusion criteria and 35 patients with C2-fractures treated either nonsurgically or surgically with motion-preserving techniques were surveyed. Outcome analysis included validated measures (SF-36, NPDI, CSOQ), and a functional CT-scanning protocol for the evaluation of C1-2 rotation and alignment. Mean followup was 64 months and mean age of patients was 52 years. Classification of C2-fractures at injury was performed using a detailed morphological description: 24 patients had odontoid fractures type II or III, 18 patients had fracture patterns involving the vertebral body and 11 included a dislocated or a burst lateral mass fracture. Thirty-one percent of patients were treated with a halo, 34% with a Philadelphia collar and 34% had anterior odontoid screw fixation. At follow-up mean atlantoaxial rotation in left and right head position was 20.2°and 20.6°, respectively. According to the classification system of posttreatment C2-alignment established by our group in part I of the C2-fracture study project, mean malunion score was 2.8 points. In 49% of patients the fractures healed in anatomical shape or with mild malalignment. In 51% fractures healed with moderate or severe malalignment. Self-rated outcome was excellent or good in 65% of patients and moderate or poor in 35%. The raw data of varying nuances allow for comparison in future benchmark studies and metaanalysis. Detailed investigation of C2-fracture morphology, posttreatment C2-alignment and atlantoaxial rotation allowed a unique outcome analysis that focused on the identification of risk factors for poor outcome and the interdependencies of outcome variables that should be addressed in studies on C2-fractures. We recognized that reduced rotation of C1-2 per se was not a concern for the patients. However, patients with worse clinical outcomes had reduced total neck rotation and rotation C1-2. In turn, C2-fractures, especially fractures affecting the lateral mass that healed with atlantoaxial deformity and malunion, had higher incidence of atlantoaxial degeneration and osteoarthritis. Patients with increased severity of C2-malunion and Electronic supplementary material The online version of this article

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Atlantoaxial Anterior Transarticular Screw Fixation: Indications and Surgical Technique

Polli,

Rapisarda,

Trungu

et al. 2023

Acta Neurochirurgica Supplement

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Anterior retropharyngeal fixation C1-2 for stabilization of atlantoaxial instabilities: study of feasibility, technical description and preliminary results

Cited by 63 publications

References 44 publications

C2-fractures: part I. Quantitative morphology of the C2 vertebra is a prerequisite for the radiographic assessment of posttraumatic C2-alignment and the investigation of clinical outcomes

C2-fractures: part I. Quantitative morphology of the C2 vertebra is a prerequisite for the radiographic assessment of posttraumatic C2-alignment and the investigation of clinical outcomes

C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes

Atlantoaxial Anterior Transarticular Screw Fixation: Indications and Surgical Technique

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