C1-C2 Posterior Fixation: Indications, Technique, and Results

Jacobson, Mark E.; Khan, Safdar N.; An, Howard S.

doi:10.1016/j.ocl.2011.09.004

Cited by 46 publications

(47 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…3,27,28 Screw malpositioning, compression of the vertebral artery, and sensory deficit due to C2 nerve root injury or dissection are the most commonly reported complications associated with Harms technique. 6,11,29 The C2 nerve root is not routinely dissected and ligated because this could lead to sensory deficit and risk for postoperative neuralgias, as confirmed by other studies in the literature. 3,30 The only indication for ligation is to control blood loss from the venous plexus, which is closely located to the C2 nerve root.…”

Section: Discussionmentioning

confidence: 88%

“…17,22,23 According to Jacobson et al, 6 posterior fixation techniques can be divided further to include the dorsal wiring technique, the transarticular atlantoaxial arthrodesis initiated by Magerl, the polyaxial screw and rod fixation invented by Harms, and finally the C2 translaminar constructs. Harms technique has been biomechanically tested in comparison to wiring arthrodesis methods and proved to be superior for flexion, extension, and rotation at the cervical level.…”

Section: Discussionmentioning

confidence: 99%

“…The vertebral artery's third segment, as well as the presence of other elements, such as the venous cervical plexus, cervical nerve roots, the atlantooccipital membrane, and the dura in addition to the risk of failure related to the fixation makes every surgical manipulation critical for an optimal radiographic and clinical outcome. [1][2][3][4][5][6] Indications for C1-C2 posterior fixation include instability caused by degenerative diseases and infections, as well as trauma, tumors, congenital malformations, and os odontoideum. 6,7 Several C1-C2 posterior fixation surgical techniques and their modifications are frequently applied.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5][6] Indications for C1-C2 posterior fixation include instability caused by degenerative diseases and infections, as well as trauma, tumors, congenital malformations, and os odontoideum. 6,7 Several C1-C2 posterior fixation surgical techniques and their modifications are frequently applied. [8][9][10][11][12][13][14][15][16][17][18][19][20][21] One of the most popularized surgical fixation techniques of the C1 lateral mass and the C2 pedicle with screws and rods is referred to in the literature as the Harms technique.…”

Section: Introductionmentioning

confidence: 99%

“…7 The anatomical exposure and the biomechanical setting of this technique provide the availability for additional intraoperative fixation maneuvers compared with other fixation methods, such as Magerl's technique, which is positively reflected in the final radiological and clinical outcome. 6,7 Our goal is to present a technical modification of the Harms technique that contributes significantly to accurate screw placement especially in the lateral mass of the C1 vertebra and less in the pedicles of the C2 vertebra.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

C1-C2 Posterior Cervical Fixation by a Harms Technique Modification

Siasios¹,

Vakharia²,

Kowalski³

et al. 2017

The Journal of Spinal Surgery

View full text Add to dashboard Cite

Introduction:The unique anatomy of the upper cervical spine in conjunction with its supportive role in the axial stabilization and rotatory function of the head increases the surgical risk and associated complications for corrective surgeries performed in this spinal region. C1-C2 posterior fixation is indicated in the occurrence of instability at the craniocervical junction; and it can be performed by specific surgical techniques, such as the Harms and Magerl techniques. In this technical note, the authors present a simplified modification of the Harms technique that increases the accuracy of screw placement in the lateral mass of the C1 vertebra and in the pedicle of the C2 vertebra. This modification provides a secure path for screw placement by obtaining fluoroscopic images of K-wires inserted in the lateral masses of C1 and the pedicles of C2 as in the original technique. According to this technique, a pin driver is used to guide a K-wire through the initially marked entry point to the lateral mass of C1. After fluoroscopic confirmation of the optimal position of the guide wire, a cannulated hand drill is placed over the guidewire. A pilot hole is drilled in the same trajectory for the screw placement under fluoroscopic control. Then the guidewire and the hand drill are removed and an appropriately sized 3.5 mm polyaxial screw is placed with a hand drill under confirmation of the correct position with anteroposterior and lateral fluoroscopy. The same procedure is followed for the placement of the C2 pedicle screws. Then, a small rod is placed and secured within the polyaxial screw heads of the C1 and C2 screws bilaterally. Decortication of the spinous processes of the involved vertebrae and the occiput is the final step before closure of the fascia, cervical muscle layer, subcutaneous tissue, and skin.

show abstract

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

C1-C2 Posterior Cervical Fixation by a Harms Technique Modification

Siasios¹,

Vakharia²,

Kowalski³

et al. 2017

The Journal of Spinal Surgery

View full text Add to dashboard Cite

show abstract

Connective tissue, Ehlers–Danlos syndrome(s), and head and cervical pain

Castori¹,

Morlino²,

Ghibellini³

et al. 2015

American J of Med Genetics Pt C

View full text Add to dashboard Cite

Ehlers-Danlos syndrome (EDS) is an umbrella term for a growing group of hereditary disorders of the connective tissue mainly manifesting with generalized joint hypermobility, skin hyperextensibility, and vascular and internal organ fragility. In contrast with other well known heritable connective tissue disorders with severe cardiovascular involvement (e.g., Marfan syndrome), most EDS patients share a nearly normal life span, but are severely limited by disabling features, such as pain, fatigue and headache. In this work, pertinent literature is reviewed with focus on prevalence, features and possible pathogenic mechanisms of headache in EDSs. Gathered data are fragmented and generally have a low level of evidence. Headache is reported in no less than 1/3 of the patients. Migraine results the most common type in the hypermobility type of EDS. Other possibly related headache disorders include tension-type headache, new daily persistent headache, headache attributed to spontaneous cerebrospinal fluid leakage, headache secondary to Chiari malformation, cervicogenic headache and neck-tongue syndrome, whose association still lacks of reliable prevalence studies. The underlying pathogenesis seems complex and variably associated with cardiovascular dysautonomia, cervical spine and temporomandibular joint instability/dysfunction, meningeal fragility, poor sleep quality, pain-killer drugs overuse and central sensitization. Particular attention is posed on a presumed subclinical cervical spine dysfunction. Standard treatment is always symptomatic and usually unsuccessful. Assessment and management procedures are discussed in order to put some basis for ameliorating the actual patients' needs and nurturing future research.

show abstract