Clinical application of C2 laminar screw technique

Ma, Weihu; Feng, Leling; Xu, Rong-ming; Liu, Xiaochen; Lee, Alan H.; Sun, Shaohua; Zhao, Liujun; Hu, Yong; Liu, Guanyi

doi:10.1007/s00586-010-1447-1

Cited by 28 publications

(25 citation statements)

References 14 publications

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“…The data from general population may not apply to patients with OO. In addition, the use of C2 laminar screws in atlantoaxial fixation in attempt to reduce the risk for the vertebral artery (VA), was first reported by Wright et al [36] in 2004 and since became popular [18,19,38]. For OO patients, however, a couple of questions arise: can C2 pedicle screw be safely placed in every OO patient?…”

Section: Introductionmentioning

confidence: 99%

The options of C2 fixation for os odontoideum: a radiographic study for the C2 pedicle and lamina anatomy

Meng

2011

Eur Spine J

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Introduction Patients with os odontoideum always present instability in atlantoaxial joint and need atlantoaxial fixation. C2 pedicle or laminar screws fixation has proven to be efficient and reliable for atlantoaxial instability. However, os odontoideum is a congenital or developmental disease, featured with anomalous bony anatomies. The anatomic measurements and guidelines for C2 pedicle screw placement in general population tends to differ with those of os odontoideum patients, for whom C2 pedicle screws are often needed. The option and techniques of C2 fixation are still challenging and yet to be fully explored. Material and methods We recruited 29 adult patients with os odontoideum and measured the dimension of C2 pedicle and lamina for each patient to examine how well do they match with the screws anatomically. In order to access the intra-observer reliability and inter-observer repeatability of the measurements, the intraclass correlation coefficient (ICC) was also calculated. Results The results for reliability of the CT measurements showed excellent intraobserver (ICC = 0.95 and 0.96) and interobserver correlation coefficient (ICC = 0.93). The diameter and length of C2 pedicle were found to be 6.06 ± 1.37 and 24.05 ± 2.54 mm, while the corresponding figures of C2 laminar were 6.95 ± 0.82 and 25.60 ± 2.18 mm, respectively. In the measurements, all 29 cases had suitable diameter (larger than 5.5 mm) for C2 laminar screw (the laminar diameters ranged from 5.52 to 8.82 mm). In C2 pedicle measurements, the diameters of the 29 cases were from 3.50 to 9.86 mm, while 20 pedicles (34.5%) in 14 cases were less than 5.5 mm in diameter. Six had bilateral small pedicles where the diameter was less than 5.5 mm. Conclusion Anatomically, we found laminar screw is a better match in comparison with pedicle screw for C2 fixation in os odontoideum. The options for C2 fixation should be made based on careful preoperative imaging and thorough consideration. Preoperative reconstructive CT scan can offer great assistance for the choice of fixation in os odontoideum by revealing the anatomy of the C2 pedicles in detail.

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Section: Introductionmentioning

confidence: 99%

The options of C2 fixation for os odontoideum: a radiographic study for the C2 pedicle and lamina anatomy

Meng

2011

Eur Spine J

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“…Ma et. al [13] lately reported on their results using C2 laminar screws for atlantoaxial instability. They had no insertion-related intraoperative complications, and all screws were placed properly.…”

Section: Discussionmentioning

confidence: 97%

Translaminar screws of the axis—an alternative technique for rigid screw fixation in upper cervical spine instability

Meyer

Kretschmer

et al. 2011

Neurosurg Rev

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C2 pedicle screws or transarticular atlantoaxial screws are technically demanding and carry an increased risk of vertebral artery injury. In up to 20% of cases, pedicle and transarticular screw placement is not possible due to a high-riding vertebral artery or very small C2 pedicles in addition to other anatomical variations. Translaminar screws have been reported to rigidly capture posterior elements of C2 and therefore appear to be a suitable alternative. We present our first experiences and clinical results with this new method in two neurosurgical spine centers. Twenty-seven adult patients were treated between 2007 and 2010 in two neurosurgical spine departments with C2 translaminar screw fixation for upper cervical spine instability of various origins (e.g., trauma, tumor, dens pseudarthrosis). Eight patients were men and 19 were women. Mean age was 68.9 years. In most cases, translaminar screws were used because of contraindications for pedicle or transarticular screws as a salvage technique. All patients were clinically assessed and had CT scans postoperatively to verify correct screw placement. Follow-up was performed with reexamination on an ambulatory basis. Mean follow-up was 7.6 months for all patients. In 27 patients, 52 translaminar screws were placed. There were no intraoperative complications. Postoperatively, we identified four screw malpositions using a new accuracy grading scale. One screw had to be revised because of violation of the spinal canal >4 mm. None of the patients had additional neurological deficits postoperatively, and all showed stable cervical conditions at follow-up. Two patients died due to causes not associated with the stabilization technique. The fusion rate for patients with C1/C2 fixation is 92.9%. Translaminar screws can be used at least as an additional technique for cases of upper cervical spine instability when pedicle screw placement is contraindicated or not possible. The current data suggest comparable biomechanical stability and fusion rates of translaminar screws to other well-known posterior fixation procedures. In addition, translaminar screw placement is technically less demanding and reduces the risk of vertebral artery injury.

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“…Губин и др. Задняя фиксация краниоцервикального перехода с использованием винтовых конструкций ции вероятность развития псевдоартроза может достигать 30 % [18,23,25,29]. В настоящее время наиболее надежной является задняя фиксация с использованием полиаксиальных винтов и стержней.…”

Section: хирургия позвоночникаunclassified

Задняя Фиксация Краниоцервикального Перехода С Использованием Винтовых Конструкций

Губин¹,

Burtsev²

2014

Хирургия позвоночника 2-2014

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Clinical application of C2 laminar screw technique

Cited by 28 publications

References 14 publications

The options of C2 fixation for os odontoideum: a radiographic study for the C2 pedicle and lamina anatomy

The options of C2 fixation for os odontoideum: a radiographic study for the C2 pedicle and lamina anatomy

Translaminar screws of the axis—an alternative technique for rigid screw fixation in upper cervical spine instability

Задняя Фиксация Краниоцервикального Перехода С Использованием Винтовых Конструкций

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