Atlantal lateral mass screws for posterior spinal reconstruction

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>A variety of techniques may be used to achieve fixation of the upper cervical spine. Transarticular atlantoaxial screws, posterior interspinous cable and graft constructs, and interlaminar clamps have been used effectively to achieve atlantoaxial fixation. Various anatomical factors, however, may preclude the successful application of these techniques. These factors include aberrant vertebral artery anatomy, irreducible atlantoaxial subluxation, exaggerated cervicothoracic kyphosis, and the absence of the osseous substrate for fixation. In these cases, an alternative method of fixation must be performed. The authors present an alternative method to achieve fixation of the atlas in which lateral mass screws can be applied to atlantoaxial and occipitocervical fixation.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Between February 1998 and November 2001, eight patients who ranged in age from 16 to 74 years underwent posterior fixation for upper cervical instability. Diagnoses included C-2 metastastic disease in two patients, irreducible odontoid fractures in two patients, atlantoaxial subluxation in two patients, and transverse ligament synovial cyst in two patients. Various anatomical factors precluded transarticular atlantoaxial screw fixation in seven patients. One patient with a highly unstable spine due to a C-2 metastasis and pathological fracture underwent occipitocervical fusion.</jats:p> <jats:p>Atlantocervical fixation was achieved in seven patients by using varying constructs incorporating C-1 lateral mass screws. Occipitocervical fixation was achieved in one patient by incorporating C-1 lateral mass screws as an additional fixation point. A total of 14 C-1 lateral mass screws were placed in eight patients. There were no intraoperative complications. In all patients rigid fixation was achieved as demonstrated on postoperative radiographs. One patient died on postoperative Day 9 of aspiration pneumonia. At a mean follow-up time of 7.4 months, rigid fixation was maintained in all patients.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Atlantal lateral mass screws can be used to provide a safe and efficacious means of achieving atlantoaxial fixation when anatomical constraints preclude the use of a more traditional procedure. Atlantal lateral mass screws may also be incorporated in occipitocervical constructs to provide additional fixation points which may prevent construct failure.</jats:p></jats:sec>

Prevalence and Morphologic Characteristics of Ponticulus Posticus: Analysis Using Cone-Beam Computed Tomography

“…55 The purported benefits include longer bony purchase, increased rigidity, less C2 ganglion manipulation and postoperative neuralgia, and less intraoperative blood loss due to less disruption of the perineural venous plexus. 9,11,56 The broad posterior arch of the atlas is the best location for this modified screw placement. Although this may be reasonable for most patients, in patients with a PP, the anomaly has the possibility of being misidentified as the broad posterior arch.…”

“…7 Since the treatment of atlantoaxial instability was revolutionized by the introduction of the C1LMS insertion, 8 many alterations to the method have been described and used successfully. [9][10][11] Young et al 4 reported that mistaking the PP for just a broad posterior arch of the atlas during C1LMS placement could cause injury to the vertebral artery.…”

Posterior atlanto-axial fixation with polyaxial C1 lateral mass screws and C2 pars screws

“…Atlanto-axial instability from trauma, tumour, inflammation, or congenital defect as well as painful osteoarthritis are recognised indications for atlanto-axial fusion [3,9,14,20]. The posterior approach is by far the most common approach for C1-C2 fixation and dorsal wiring techniques have increasingly been replaced by newer screw fixation techniques [3,9,10,12,14,15,[18][19][20].…”

“…The posterior approach is by far the most common approach for C1-C2 fixation and dorsal wiring techniques have increasingly been replaced by newer screw fixation techniques [3,9,10,12,14,15,[18][19][20].…”

C1 lateral mass screw-induced occipital neuralgia: a report of two cases

“…This highlights theIntroduction C1 lateral mass screw fixation was first described in 1994 by Goel and Laheri [3] and popularized by Harms and Melcher in 2001 [6]. The advantages of this technique over the Magerl transarticular screw technique include the intraoperative ability to reduce C1/2 subluxation and a theoretical reduction in the risk of vertebral artery injury [1,2]. While occipital neuralgia has been recognized as a possible complication of C1 lateral mass fixation, there have been few documented reports to date.…”