Occiput/C1–C2 fixations using intra-laminar screw of axis – A long-term follow-up

Sinha, Shalini; Jagetia, Anita; Aher, Rajendra B; Butte, Manoj Kumar V.

doi:10.3109/02688697.2014.987211

Cited by 3 publications

(3 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…42 Based on reports in the literature of the small series of children and slightly larger patient series of adults in which C2 translaminar screws are used, the follow-up and fusion rate are quite satisfactory. 138…”

Section: C1 Lateral Mass Screws and C1-2 Transarticular Screws The Bmentioning

confidence: 99%

Spinal instrumentation in infants, children, and adolescents: a review

Mendenhall

Mobasser

Relyea

et al. 2019

Journal of Neurosurgery: Pediatrics

View full text Add to dashboard Cite

OBJECTIVEThe evolution of pediatric spinal instrumentation has progressed in the last 70 years since the popularization of the Harrington rod showing the feasibility of placing spinal instrumentation into the pediatric spine. Although lacking in pediatric-specific spinal instrumentation, when possible, adult instrumentation techniques and tools have been adapted for the pediatric spine. A new generation of pediatric neurosurgeons with interest in complex spine disorder has pushed the field forward, while keeping the special nuances of the growing immature spine in mind. The authors sought to review their own experience with various types of spinal instrumentation in the pediatric spine and document the state of the art for pediatric spine surgery.METHODSThe authors retrospectively reviewed patients in their practice who underwent complex spine surgery. Patient demographics, operative data, and perioperative complications were recorded. At the same time, the authors surveyed the literature for spinal instrumentation techniques that have been utilized in the pediatric spine. The authors chronicle the past and present of pediatric spinal instrumentation, and speculate about its future.RESULTSThe medical records of the first 361 patients who underwent 384 procedures involving spinal instrumentation from July 1, 2007, to May 31, 2018, were analyzed. The mean age at surgery was 12 years and 6 months (range 3 months to 21 years and 4 months). The types of spinal instrumentation utilized included occipital screws (94 cases); C1 lateral mass screws (115 cases); C2 pars/translaminar screws (143 cases); subaxial cervical lateral mass screws (95 cases); thoracic and lumbar spine traditional-trajectory and cortical-trajectory pedicle screws (234 cases); thoracic and lumbar sublaminar, subtransverse, and subcostal polyester bands (65 cases); S1 pedicle screws (103 cases); and S2 alar-iliac/iliac screws (56 cases). Complications related to spinal instrumentation included hardware-related skin breakdown (1.8%), infection (1.8%), proximal junctional kyphosis (1.0%), pseudarthroses (1.0%), screw malpositioning (0.5%), CSF leak (0.5%), hardware failure (0.5%), graft migration (0.3%), nerve root injury (0.3%), and vertebral artery injury (0.3%).CONCLUSIONSPediatric neurosurgeons with an interest in complex spine disorders in children should develop a comprehensive armamentarium of safe techniques for placing rigid and nonrigid spinal instrumentation even in the smallest of children, with low complication rates. The authors’ review provides some benchmarks and outcomes for comparison, and furnishes a historical perspective of the past and future of pediatric spine surgery.

show abstract

Section: C1 Lateral Mass Screws and C1-2 Transarticular Screws The Bmentioning

confidence: 99%

Spinal instrumentation in infants, children, and adolescents: a review

Mendenhall

Mobasser

Relyea

et al. 2019

Journal of Neurosurgery: Pediatrics

View full text Add to dashboard Cite

show abstract

“…To avoid VA injury, Wright described C-2 LSs in 2004, 19 which have been widely used with favorable results. 11 Because the axis of the C-2 LS was different than that of the C-1 PS and the atlantoaxial displacement, we found the C-2 LS was a suboptimal anchor point for atlantoaxial reduction. We used unilateral PSs as a reductive anchor, and after the reduction, C-2 LSs were employed on the contralateral side to strengthen the fixation.…”

Section: Discussionmentioning

confidence: 84%

Treatment of atlantoaxial dislocations among patients with cervical osseous or vascular abnormalities utilizing hybrid techniques

Wang

Tian

Diebo

et al. 2018

Journal of Neurosurgery: Spine

View full text Add to dashboard Cite

OBJECTIVEMost cervical fixations for atlantoaxial dislocation (AAD) are bilateral and symmetric; however, in the setting of osseous and vascular deformity at the craniovertebral junction, asymmetrical and hybrid fixations are used as “salvage” techniques. Because of the rarity of these cases, hybrid cervical fixations for AAD have not been fully explored. The aim of this study was to evaluate the clinical feasibility and outcomes of posterior hybrid cervical fixations for AAD.METHODSTwenty-one AAD cases were retrospectively studied; 18 had cervical myelopathy with Japanese Orthopaedic Association (JOA) scores ranging from 9 to 16 (mean 13.5). Hybrid fixation techniques included unilateral pedicle screws, transarticular screws, C-2 laminar screws, cervical lateral mass screws, and spinous process screws. During the same period, 82 AAD cases, treated using symmetric traditional fixations, were analyzed as controls.RESULTSAtlantoaxial fixation was performed in 11 cases, while occiput-cervical fixation was used in 10 cases. All cases achieved solid osseous fusion. Anatomical reduction was achieved in 20 cases (95.2%). All 18 cases with myelopathy showed postoperative improvement, with JOA scores ranging from 13 to 17 (mean 15.5). Three cases (14.2%) experienced complications, including delayed wound healing, CSF leakage, and fixation loosening. Hybrid fixation techniques showed significantly greater estimated blood loss when compared with controls (208.1 ± 19.30 ml vs 139.63 ± 8.75 ml, p = 0.001). Operative duration (125.38 ± 6.29 min vs 119.41 ± 3.77 min, p = 0.464), complication rates (14.3% vs 4.9%, p = 0.148), and JOA improvement rates (61% ± 7% vs 49% ± 4%, p = 0.161) showed no significant differences.CONCLUSIONSFor ADD with osseous or vascular deformity, posterior cervical reduction and stabilization can be achieved using hybrid techniques, resulting in comparable clinical results to symmetric traditional fixation.

show abstract

“…[123456789] Rigid constructs have been shown in biomechanical studies to provide superior fixation to semi-rigid constructs. [479101112131415] Rods are contoured to connect an occipital plate and upper cervical spine screws,[479] inviting biomechanical fatigue failure of the rod. [8] Hinged rod systems, comprised two rods connected to each other at a hinge, allow fixation without rod bending [Figure 1].…”

Section: Introductionmentioning

confidence: 99%

Comparison of hinged and contoured rods for occipitocervical arthrodesis in adults: A clinical study

Abode-Iyamah

Dlouhy

Lopez

et al. 2016

J Craniovert Jun Spine

View full text Add to dashboard Cite

Introduction:A rigid construct that employs an occipital plate and upper cervical screws and rods is the current standard treatment for craniovertebral junction (CVJ) instability. A rod is contoured to accommodate the occipitocervical angle. Fatigue failure has been associated these acute bends. Hinged rod systems have been developed to obviate intraoperative rod contouring.Object:The aim of this study is to determine the safety and efficacy of the hinged rod system in occipitocervical fusion.Materials and Methods:This study retrospectively evaluated 39 patients who underwent occipitocervical arthrodesis. Twenty patients were treated with hinged rods versus 19 with contoured rods. Clinical and radiographic data were compared and analyzed.Results:Preoperative and postoperative Nurick and Frankel scores were similar between both groups. The use of allograft, autograft or bone morphogenetic protein was similar in both groups. The average number of levels fused was 4.1 (±2.4) and 3.4 (±2) for hinged and contoured rods, respectively. The operative time, estimated blood loss, and length of stay were similar between both groups. The occiput to C2 angle was similarly maintained in both groups and all patients demonstrated no movement across the CVJ on flexion-extension X-rays during their last follow-up. The average follow-up for the hinged and contoured rod groups was 12.2 months and 15.9 months, respectively.Conclusion:Hinged rods provide a safe and effective alternative to contoured rods during occipitocervical arthrodesis.

show abstract

Occiput/C1–C2 fixations using intra-laminar screw of axis – A long-term follow-up

Abstract: Intra-laminar screw fixation is a safe alternative to transarticular and transpedicular/pars interarticularis fixation of C2 with advantage of having no risk of injury to vertebral artery and comparable biomechanical and pull-out strength.

Cited by 3 publications

References 10 publications

Spinal instrumentation in infants, children, and adolescents: a review

Spinal instrumentation in infants, children, and adolescents: a review

Treatment of atlantoaxial dislocations among patients with cervical osseous or vascular abnormalities utilizing hybrid techniques

Comparison of hinged and contoured rods for occipitocervical arthrodesis in adults: A clinical study

Contact Info

Product

Resources

About