Differences in fixation strength among constructs of atlantoaxial fixation

Chang, Chia Chin; Huang, Wen Cheng; Tu, Tsung Hsi; Chang, Po-Ya; Fay, Li Yu; Wu, Jau Ching; Cheng, Henrich

doi:10.3171/2018.6.spine171390

Cited by 25 publications

(14 citation statements)

References 33 publications

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“…Paramore reported a high riding C2 transverse foramen in 18% of patients [ 75 ]. A high riding vertebral artery was present in 50 to 70% of patients with Down syndrome, rheumatoid arthritis, basilar invagination, Klippel-Feil syndrome, and congenital skeletal anomalies [ 11 ]. Madawi found that the pedicle anatomy precluded safe screw placement in 20% of patients [ 60 ].…”

Section: Discussionmentioning

confidence: 99%

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Atlanto-axial rotary instability (Fielding type 1): characteristic clinical and radiological findings, and treatment outcomes following alignment, fusion, and stabilization

et al. 2020

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Atlanto-axial instability (AAI) is common in the connective tissue disorders, such as rheumatoid arthritis, and increasingly recognized in the heritable disorders of Stickler, Loeys-Dietz, Marfan, Morquio, and Ehlers-Danlos (EDS) syndromes, where it typically presents as a rotary subluxation due to incompetence of the alar ligament. This retrospective, IRB-approved study examines 20 subjects with Fielding type 1 rotary subluxation, characterized by anterior subluxation of the facet on one side, with a normal atlanto-dental interval. Subjects diagnosed with a heritable connective tissue disorder, and AAI had failed non-operative treatment and presented with severe headache, neck pain, and characteristic neurological findings. Subjects underwent a modified Goel-Harms posterior C1-C2 screw fixation and fusion without complication. At 15 months, two subjects underwent reoperation following a fall (one) and occipito-atlantal instability (one). Patients reported improvement in the frequency or severity of neck pain (P < 0.001), numbness in the hands and lower extremities (P = 0.001), headaches, pre-syncope, and lightheadedness (all P < 0.01), vertigo and arm weakness (both P = 0.01), and syncope, nausea, joint pain, and exercise tolerance (all P < 0.05). The diagnosis of Fielding type 1 AAI requires directed investigation with dynamic imaging. Alignment and stabilization is associated with improvement of pain, syncopal and near-syncopal episodes, sensorimotor function, and exercise tolerance.

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Section: Discussionmentioning

confidence: 99%

“…The authors strongly endorse careful study of thin-slice axial and sagittal computerized tomography scans of the C1-C2 complex, to select screw length and trajectory [ 11 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Atlanto-axial rotary instability (Fielding type 1): characteristic clinical and radiological findings, and treatment outcomes following alignment, fusion, and stabilization

et al. 2020

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“…Most cases achieved satisfied reduction with symptoms relieved using this technique. 24,25 Furthermore, to increase bony fusion, 1 or 2 cross-linkages were used to the axial stability, and finally 95.8% fusion rates were observed in our study. 26 Based on our clinical experience, there are several operative nuances of using such reduction technique.…”

Section: Discussionmentioning

confidence: 56%

Treatment of Reducible Atlantoaxial Dislocation and Basilar Invagination Using the Head Frame Reduction Technique and Atlantoaxial Arthrodesis

Yin

et al. 2020

Global Spine Journal

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Study design: Retrospective case series. Object: To evaluate the outcomes of a head frame reduction and atlantoaxial arthrodesis technique for the treatment of reducible basilar invagination (BI) and atlantoaxial dislocation (AAD). Methods: Seventy-two reducible BI and AAD cases who were treated with the head frame reduction and atlantoaxial arthrodesis technique from June 2015 to December 2018 were retrospectively analyzed. Radiological measurements including the atlantodental interval (ADI), the height of odontoid process above Chamberlain line, Wackenheim line, clivus-canal angle (CCA) and JOA score were evaluated. Results: There was no death in this series. The follow-up period ranged from 6 to 32 months (mean: 21.2 months). Radiological, complete or 90% reduction was attained and complete decompression was demonstrated in all patients. The CCA increased from 123.22 ± 8.36 preoperatively to 143.05 ± 8.79 postoperatively (P < 0.01). There was no patient found postoperative dysphagia. Neurological improvement was observed in all patients, with the JOA scores increasing from 12.53 ± 1.93 preoperatively to 16.13 ± 1.23 postoperatively (P < 0.01). Solid bony fusion was demonstrated in 69 patients at follow-up (95.8%). Conclusion: Head frame reduction technique is a simple and effective treatment which could relief neurologic compression and adjust the CCA in patients with reducible AAD and BI with lower potential risks. Atlantoaxial fixation with short segmental fixation, strong purchase and low shearing force could maintain superior stabilization. The safety and long-term efficacy of such fixation and reduction technique were favorable, which illustrated that it could be a promising treatment algorithm for such kind of disease.

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“…Elliott et al 22 reported that pseudarthrosis occurred in a greater proportion of patients treated with C2 pars screws (4.4%) compared with C2 pedicle screws (0.22%). In a series presented by Chang et al, 23 translaminar screws significantly lowered the success rate of C1-2 fixation (57.1% in cases of bilateral translaminar screws, and 78.9% in cases of unilateral translaminar screws) compared with bilateral C2 pedicle screws (100%). Therefore, C2 pars screws and laminar screws may not be ideal alternative options for patients with atlantoaxial instability requiring extra-rigid immobilization to maintain reduction and achieve fusion.…”

Section: Discussionmentioning

confidence: 90%

C2 medial pedicle screw: a novel “in-out-in” technique as an alternative option for posterior C2 fixation in cases with a narrow C2 isthmus

Du¹,

Yin²,

Qiao³

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEThe authors describe a novel “in-out-in” technique as an alternative option for posterior C2 screw fixation in cases that involve narrow C2 isthmus. Here, they report the preliminary radiological and clinical outcomes in 12 patients who had a minimum 12-month follow-up period.METHODSTwelve patients with basilar invagination and atlantoaxial dislocation underwent atlantoaxial reduction and fixation. All patients had unilateral hypoplasia of the C2 isthmus that prohibited insertion of pedicle screws. A new method, the C2 medial pedicle screw (C2MPS) fixation, was used as an alternative. In this technique, the inner cortex of the narrow C2 isthmus was drilled to obtain space for screw insertion, such that the lateral cortex could be well preserved and the risk of vertebral artery injury could be largely reduced. The C2MPS traveled along the drilled inner cortex into the anterior vertebral body, achieving a 3-column fixation of the axis with multicortical purchase.RESULTSSatisfactory C2MPS placement and reduction were achieved in all 12 patients. No instance of C2MPS related vertebral artery injury or dural laceration was observed. There were no cases of implant failure, and solid fusion was demonstrated in all patients.CONCLUSIONSThis novel in-out-in technique can provide 3-column rigid fixation of the axis with multicortical purchase. Excellent clinical outcomes with low complication rates were achieved with this technique. When placement of a C2 pedicle screw is not possible due to anatomical constraints, the C2MPS can be considered as an efficient alternative.

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Differences in fixation strength among constructs of atlantoaxial fixation

Cited by 25 publications

References 33 publications

Atlanto-axial rotary instability (Fielding type 1): characteristic clinical and radiological findings, and treatment outcomes following alignment, fusion, and stabilization

Atlanto-axial rotary instability (Fielding type 1): characteristic clinical and radiological findings, and treatment outcomes following alignment, fusion, and stabilization

Treatment of Reducible Atlantoaxial Dislocation and Basilar Invagination Using the Head Frame Reduction Technique and Atlantoaxial Arthrodesis

C2 medial pedicle screw: a novel “in-out-in” technique as an alternative option for posterior C2 fixation in cases with a narrow C2 isthmus

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