Complications of sublaminar wiring

Geremia, Glen; Kim, Kwang S.; Cerullo, Leonard J.; Calenoff, Leonid

doi:10.1016/0090-3019(85)90017-5

Cited by 88 publications

(30 citation statements)

References 9 publications

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“…Likewise, after placement of transarticular screws, most surgeons augment the construct with a posterior fusion construct that involves passing sub-laminar wires and placement of an autograft taken form the iliac crest. The passage of sub-laminar wires in the cervical spine carries a 7-17% risk of neurologic deterioration, although these risks are felt to be lower at the atlantoaxial level [10,14,17,30,40,41]. Also, if the posterior arch of C1 needs to be removed surgically for decompression or if it is incomplete as occurs in 1.5-5% of the population [15,34], it would be difficult or impossible to place sub-laminar wires.…”

Section: Discussionmentioning

confidence: 99%

Treatment of pediatric atlantoaxial instability with traditional and modified Goel–Harms fusion constructs

et al. 2009

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There are several treatment options for rigid fixation at C1-C2 including Brooks and Gallie type wired fusions and C1-2 transarticular screws. The use of a GoelHarms type fusion, a construct with C1 lateral mass screws and C2 pedicle screws, has not been extensively described in pediatric patients. Here, we describe its relatively safe and effective use for treating pediatric patients by retrospective chart review of patients treated by the senior author for atlantoaxial instability with a Goel-Harms-type constructs during a 3-year period (2005)(2006)(2007). Six patients were treated using Goel-Harms-type constructs. Five patients were treated utilizing a construct containing C1 lateral mass screws and C2 pedicle screws; one patient was treated using construct containing C1 lateral mass screws and C2 trans-laminar screws. The patients ranged in age from 7 to 17 years old (mean 12.7). All patients had findings of an os odontoideum on CT scans and three of the six patients had T2 hyperintensity on MRI. Three of the six patients presented with transient neurologic deficits: quadraplegia in two patients and paresthesias in two patients. In each patient C1 lateral mass and C2 screws were placed and the subluxation was reduced to attain an anatomical alignment. No bone grafts were harvested from the iliac crest or rib. Local morsalized bone and sub-occipital skull graft was used. All patients tolerated the procedure well and were discharged home on post-operative day 3-4. The patients wore a hard cervical collar and no halo-vests were needed. All patients had solid fusion constructs and normal alignment on post-operative imaging studies performed on average 14 months post-operatively (range: 7-29). The results demonstrated that Goel-Harms fusions are a relatively safe and effective method of treating pediatric patients with atlantoaxial instability and are not dependent on vertebral anatomy or an intact ring of C1. Follow-up visits and studies in this limited series of patients demonstrated solid fusion constructs and anatomical alignment in all patients treated.

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Section: Discussionmentioning

confidence: 99%

Treatment of pediatric atlantoaxial instability with traditional and modified Goel–Harms fusion constructs

et al. 2009

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“…Stab incisions as per image guidance bilaterally allow the desired screw trajectory aiming toward the upper half of the C1 anterior tubercle. Use of neuronavigation to confirm screw trajectory minimises the danger of encountering either the vertebral artery (which may easily be damaged with a lateral or inferior trajectory (Geremia et al 1985) or the spinal cord. The vertebral artery is most at risk from a trajectory that is too low rather than one that is too lateral.…”

Section: C1c2 Transarticular Screwsmentioning

confidence: 99%

Surgical Considerations of Rheumatoid Disease Involving the Craniocervical Junction and Atlantoaxial Vertebrae

Murphy¹,

McEvoy²,

Bolger³

2012

Rheumatoid Arthritis - Etiology, Consequences and Co-Morbidities

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“…14,15 In 1991, Sonntag described a modification of the Gallie technique to avoid the limitations described above. 3 Briefly, a bicortical graft is wedged between the lamina of C1 and C2 and secured by a sublaminar cable passing under the C1 lamina and trapping the graft by looping around the C2 spinous process and tightening the free cable ends underneath the spinous process of C2, ie.…”

Section: A B a B Cmentioning

confidence: 99%

Modified Brooks PosteriorWiring Technique for Three-Point C1-C2 Arthrodesis

Vecil

Chan

Hurlbert

2001

Can. j. neurol. sci.

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Instability of the upper cervical spine can have devastating neurological consequences. Tumors, rheumatoid arthritis, fractures, ligamentous injuries, and congenital malformations are but a few of the pathological conditions that can contribute to instability at the atlantoaxial junction, already the most mobile region of the vertebral column. Operative C1-C2 arthrodesis is required to stabilize this segment when rigid external fixation is unlikely to result in fusion.1 The limitations and variable fusion rates following the traditional posterior wiring methods of Gallie and Brooks have resulted in the development of a variety of modifications and supplemental techniques that are now available to the spinal surgeon.2 These include the interspinous modified Gallie or Sonntag technique, 3 Halifax interlaminar clamps, 4 and posterior transarticular screws. 5 Of these, transarticular screw fixation augmented by posterior bone grafting has become the standard of care in experienced hands. 6 We describe a modification of the Brooks wiring technique as an adjunct for C1-C2 transarticular screw fixation, with improved versatility and theoretical biomechanical advantages over other methods. The focus of this report is to provide a detailed description of this new technique and its advantages. OPERATIVE PROCEDUREFollowing the induction of general anesthesia, skull pin fixation is applied and the patient rolled onto the operating table in a prone position (a traction device or Jackson table is not ABSTRACT: Background: The optimal surgical treatment of atlanto-axial instability remains controversial despite the variety of modifications and supplemental techniques currently available. Methods: We describe a modification of the Brooks posterior wiring technique supplemented with transarticular screws for C1-C2 instability. Results: This method has been implemented in 30 patients in our institution with no radiological failures. Conclusions: The modification provides several technical advantages and potentially stronger fixation compared to methods currently in use.

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Complications of sublaminar wiring

Cited by 88 publications

References 9 publications

Treatment of pediatric atlantoaxial instability with traditional and modified Goel–Harms fusion constructs

Treatment of pediatric atlantoaxial instability with traditional and modified Goel–Harms fusion constructs

Surgical Considerations of Rheumatoid Disease Involving the Craniocervical Junction and Atlantoaxial Vertebrae

Modified Brooks PosteriorWiring Technique for Three-Point C1-C2 Arthrodesis

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