Posterior occipitocervical (C0–3) fusion using polyaxial occipital condyle to cervical spine screw and rod fixation: a radiographic and cadaveric analysis

Frankel, Bruce; Hanley, Michael; Vandergrift, Alex; Monroe, Timothy; Morgan, Steven; Rumboldt, Zoran

doi:10.3171/2009.11.spine09172

Cited by 33 publications

(38 citation statements)

References 55 publications

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“…Other anatomical structures possibly affected by the C0-C1 transarticular screw are the C2 root and surrounding venous plexus. 5,21,23) If the C2 root hinders screw positioning or visualization of the screw entry point, the C2 root can be resected to achieve reasonable space and angle for screw placement. The incidence of neuropathic pain from C2 root sacrifice is very low.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical and Morphometric Evaluation of Occipital Condyle for Occipitocervical Segmental Fixation

Hong

Takigawa

Sugisaki

et al. 2011

Neurol. Med. Chir.(Tokyo)

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Two recent novel techniques of occipital fixation are the occipitoatlantal (C0-C1) transarticular screw technique and the direct occipital condyle screw technique. The present study evaluated and compared the biomechanical stability of the direct occipital condyle screw and C0-C1 transarticular screw with the established method for craniocervical spine fixation using the midline occipital keel screw and C1 lateral mass screw. Morphometric evaluation of the occipital condyle and the hypoglossal canal was performed to avoid hypoglossal nerve injury during the screw placement. Thirteen recently frozen cadaveric specimens were used. The occipital condyle anatomy and the hypoglossal canal dimension were measured using reconstructed computed tomography images. Insertion torque and pullout strength were evaluated to compare the midline occipital keel screw, C0-C1 transarticular screw, C1 lateral mass screw, and direct occipital condyle screw. The dimensions of the occipital condyle allow use of a 3.5 or 4.0-mm diameter screw. Mean pullout strength was 1619.6 N for the midline occipital keel screw, 870.7 N for the C0-C1 transarticular screw, 707.0 N for the C1 lateral mass screw, and 431.7 N for the direct occipital condyle screw. Mean insertion torque was 0.55 Nm for the midline occipital keel screw, 0.32 Nm for the C0-C1 transarticular screw, 0.14 Nm for the C1 lateral mass screw, and 0.11 Nm for the direct occipital condyle screw. The condylar anatomy allows direct insertion of the occipital condyle screw and C0-C1 transarticular screw. These techniques are suitable options for the treatment of craniovertebral junction instabilities in selected patients.

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Section: Discussionmentioning

confidence: 99%

Biomechanical and Morphometric Evaluation of Occipital Condyle for Occipitocervical Segmental Fixation

Hong

Takigawa

Sugisaki

et al. 2011

Neurol. Med. Chir.(Tokyo)

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“…6 Occipitocervical fixation from C0-C2 (n = 3) and C0-T2 (n = 1) was performed with the goal of decompression and stabilization of this region. All patients had preoperative neurological dysfunction.…”

Section: Study Samplementioning

confidence: 99%

“…Adult cadaveric studies have demonstrated the occipital condyles (C-0) to be a feasible fixation point. 4,6,13,14,21,[30][31][32] Subsequently, successful demonstration of this technique has been reported in adults 6,30 and in 1 pediatric patient. 4 In this paper, we present a series of 4 pediatric patients using our described technique.…”

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confidence: 99%

Occipital condyle to cervical spine fixation in the pediatric population

Kosnik-Infinger

Glazier

Frankel

2014

PED

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Fixation at the craniovertebral junction (CVJ) is necessary in a variety of pediatric clinical scenarios. Traditionally an occipital bone to cervical fusion is preformed, which requires a large amount of hardware to be placed on the occiput of a child. If a patient has previously undergone a posterior fossa decompression or requires a decompression at the time of the fusion procedure, it can be difficult to anchor a plate to the occipital bone. The authors propose a technique that can be used when faced with this difficult challenge by using the occipital condyle as a point of fixation for the construct. Adult cadaveric and a limited number of case studies have been published using occipital condyle (C-0) fixation. This work was adapted for the pediatric population. Between 2009 and 2012, 4 children underwent occipital condyle to axial or subaxial spine fixation. One patient had previously undergone posterior fossa surgery for tumor resection, and 1 required decompression at the time of operation. Two patients underwent preoperative deformity reduction using traction. One child had a Chiari malformation Type I. Each procedure was performed using polyaxial screw-rod constructs with intraoperative neuronavigation supplemented by a custom navigational drill guide. Smooth-shanked 3.5-mm polyaxial screws, ranging in length from 26 to 32 mm, were placed into the occipital condyles. All patients successfully underwent occipital condyle to cervical spine fixation. In 3 patients the construct extended from C-0 to C-2, and in 1 from C-0 to T-2. Patients with preoperative halo stabilization were placed in a cervical collar postoperatively. There were no new postoperative neurological deficits or vascular injuries. Each patient underwent postoperative CT, demonstrating excellent screw placement and evidence of solid fusion. Occipital condyle fixation is an effective option in pediatric patients requiring occipitocervical fusion for treatment of deformity and/or instability at the CVJ. The use of intraoperative neuronavigation allows for safe placement of screws into C-0, especially when faced with a challenging patient in whom fixation to the occipital bone is not possible or is less than ideal.

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“…Real-time CT-based intraoperative neuronavigation can diminish the possibility of such inaccuracies. 13 Iso-C3D navigation has been well described for use in cervical spine surgery. 13,16,24 Hott et al demonstrated the intraoperative use of the Iso-C3D C-arm in a series of 30 patients with varied pathology of the cervical spine, including traumatic, degenerative, congenital, and neoplastic conditions.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive percutaneous screw fixation of traumatic spondylolisthesis of the axis

Buchholz¹,

Morgan²,

Robinson³

et al. 2015

SPI

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OBJECT Most cases of traumatic spondylolisthesis of the axis (hangman's fracture) can be treated nonoperatively with reduction and subsequent immobilization in a rigid cervical collar or halo. However, in some instances, operative management is necessary and can be accomplished by using either anterior or posterior fusion techniques. Because open posterior procedures can result in significant blood loss, pain, and limited cervical range of motion, other less invasive options for posterior fixation are needed. The authors describe a minimally invasive, navigation-guided technique for surgical treatment of Levine-Edwards (L-E) Type II hangman's fractures. METHODS For 5 patients with L-E Type II hangman's fracture requiring operative reduction and internal fixation, percutaneous screw fixation directed through the fracture site was performed. This technique was facilitated by use of intraoperative 3D fluoroscopy and neuronavigation. RESULTS Of the 5 patients, 2 were women, 3 were men, and age range was 46–67 years. No intraoperative or postoperative complications occurred. All patients wore a rigid cervical collar, and flexion-extension radiographs were obtained at 6 months. For all patients, dynamic imaging demonstrated a stable construct. CONCLUSIONS L-E type II hangman's fractures can be safely repaired by using percutaneous minimally invasive surgical techniques. This technique may be appropriate, depending on circumstances, for all L-E Type I and II hangman's fractures; however, the degree of associated ligament injury and disc disruption must be accounted for. Percutaneous fixation is not appropriate for L-E Type III fractures because of significant displacement and ligament and disc disruption. This report is meant to serve as a feasibility study and is not meant to show superiority of this procedure over other surgical options.

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Posterior occipitocervical (C0–3) fusion using polyaxial occipital condyle to cervical spine screw and rod fixation: a radiographic and cadaveric analysis

Cited by 33 publications

References 55 publications

Biomechanical and Morphometric Evaluation of Occipital Condyle for Occipitocervical Segmental Fixation

Biomechanical and Morphometric Evaluation of Occipital Condyle for Occipitocervical Segmental Fixation

Occipital condyle to cervical spine fixation in the pediatric population

Minimally invasive percutaneous screw fixation of traumatic spondylolisthesis of the axis

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