C2 Pedicle Screws Combined With C1 Laminar Hooks for Reducible Atlantoaxial Dislocation: An Ideal Salvage Technique for C1-C2 Pedicle Screws

Abstract

BACKGROUND A C1 laminar hook can theoretically avoid vertebral artery injury and is less technically demanding. However, only few studies with small samples analyzed the short-term outcomes of C2 pedicle screws combined with C1 laminar hooks (C2PS-C1LH) technique in the treatment of atlantoaxial dislocation. Furthermore, it is not confirmed whether similar clinical outcomes can be achieved with C1-C2 pedicle screw and rod construct (PSRC). OBJECTIVE To evaluate the outcomes of C2PS-C1LH and C1-C2 PSRC fixation techniques for treating atlantoaxial dislocation. METHODS Data of 52 patients with atlantoaxial dislocation treated by C1-C2 PSRC or C2PS-C1LH fixation were retrospectively reviewed. Outcomes evaluated by visual analog scale score for neck pain (VASSNP), Neck Disability Index (NDI), atlantodental interval (ADI), and the perioperative parameters including blood loss and operation time were analyzed and compared between 2 techniques. Patient satisfaction at final follow-up was also investigated. RESULTS There were no complications related to the surgical approach and instrumentation in either group. The mean bone fusion time was 5.06 ± 1.65 mo for the C2PS-C1LH group and 3.93 ± 0.99 mo for the C1-C2 PSRC group (P > .05). Hundred percent of fusion rates were achieved in both groups at month 12 after operation. The ADI, VAS scores, the NDI scores, and the JOA scores were greatly improved in both the groups (P < .05), but there were no significant differences between the 2 groups. CONCLUSION C2PS-C1LH fixation technique was comparable to C1-C2 PSRC in the treatment of reducible atlantoaxial dislocation. C2PS-C1LH fixation was an ideal alternative strategy to C1-C2 PSRC fixation.

Biomechanical comparison and operation on cadaver of a novel atlantoaxial lateral mass cage

“…This method can provide strong xation and stability of the atlantoaxial joint by means of further bone fusion, but immediate postoperative stability is mainly dependent on the pedicle screws and rods. Patients need to stay in bed or continue to wear collar for a long period to improve stability and create a stable environment to promote the fusion [7] . At the same time, this method of bone grafting is under the risks of bone resorption, nonunion and secondary trauma in the iliac area, such as pain and more incisions.…”

Feasibility of 3.5 mm C2 pedicle screws in children: A computerized tomography analysis

“…Children grow continuously, and the anatomy of their upper cervical spine is more complicated than in adults. Studies of posterior atlantoaxial pedicle screw fusion fixation have mainly focused on adults (Brockmeyer et al, 2018; Han et al, 2020; Larsen et al, 2018; Wenning & Hoffmann, 2020). Also, posterior C2 pedicle screw fixation in children is not commonly practiced (Guo et al, 2020).…”