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

Abstract

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.

6 Craniocervical Fixation with a Contoured Plate:The OctaFix System

“…7 Sighting along the pars from the caudal end of the incision allows one to plan an entry point so that the trajectory of the screw will have a slightly medial angulation as it is inserted. In most cases the entry point is ϳ3 mm above the C2-C3 facet joint and 3 mm lateral to the spinal canal.…”