Stable Posterior Fusion of the Atlas and Axis by Transarticular Screw Fixation

Magerl, F.; Seemann, P.

doi:10.1007/978-3-7091-8882-8_59

Cited by 517 publications

(383 citation statements)

References 4 publications

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“…Pedicle screw fixation and C1/2 transarticular screw fixation are biomechanically superior to other conventional procedures using wiring or clamping [1,9,14,17]. Furthermore, pedicle screw fixation is a useful technique because laminectomy or laminoplasty can be performed simultaneously.…”

Section: Discussionmentioning

confidence: 99%

“…The following surgical procedures were performed with the aid of image-guidance systems: C1/2 transarticular screw (Trans Bone Screw; KiscoMedica, St Priest, France) fixation (Magerl's procedure [17]) in six patients, cervicothoracic fusion using transpedicular screws (Cervical Pedicle Screw System; Depuy Spine, Inc., Raynham, MA) in four patients, occipitocervical or occipitothoracic fusion using the Olerud cervical system (Nord Opedic, Askim, Sweden) in six patients, and RRS Loop Spinal System (Robert Leid, Tokyo, Japan) in five patients (Table 1). All patients had autogenous iliac bone grafts.…”

Section: Methodsmentioning

confidence: 99%

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Computer-assisted screw insertion for cervical disorders in rheumatoid arthritis

et al. 2006

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To reconstruct highly destructed unstable rheumatoid arthritis (RA) cervical lesions, the authors have been using C1/2 transarticular and cervical pedicle screw fixations. Pedicle screw fixation and C1/2 transarticular screw fixation are biomechanically superior to other fixation techniques for RA patients. However, due to severe spinal deformity and small anatomical size of the vertebra, including the lateral mass and pedicle, in the most RA cervical lesions, these screw fixation procedures are technically demanding and pose the potential risk of neurovascular injuries. The purpose of this study was to evaluate the accuracy and safety of cervical pedicle screw insertion to the deformed, fragile, and small RA spine lesions using computer-assisted image-guidance systems. A frameless, stereotactic image-guidance system that is CT-based, and optoelectronic was used for correct screw placement. A total of 21 patients (16 females, 5 males) with cervical disorders due to RA were surgically treated using the image-guidance system. Postoperative computerized tomography and plane X-ray was used to determine the accuracy of the screw placement. Neural and vascular complications associated with screw insertion and postoperative neural recovery were evaluated. Postoperative radiological evaluations revealed that only 1 (2.1%; C4) of 48 screws inserted into the cervical pedicle had perforated the vertebral artery canal more than 25% (critical breach). However, no neurovascular complications were observed. According to Ranawat's classification, 9 patients remained the same, and 12 patients showed improvement. Instrumentation failure, loss of reduction, or nonunion was not observed at the final followup (average 49.5 months; range 24-96 months). In this study, the authors demonstrated that image-guidance systems could be applied safely to the cervical lesions caused by RA. Image-guidance systems are useful tools in preoperative planning and in transarticular or transpedicular screw placement in the cervical spine of RA patients.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Computer-assisted screw insertion for cervical disorders in rheumatoid arthritis

et al. 2006

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“…If the dens fracture is unstable and the traumatic spondylolisthesis is stable, C1-C2 posterior fusion by the Gallie technique may not be sufficient to achieve the stability and union. We advocate transarticular C1-C2 screw fixation [12,22] to spare cervical motion, instead of an occipito-cervical arthrodesis. If the traumatic spondylolisthesis is unstable (i.e.…”

Section: Combined Upper Cervical Spine Injuriesmentioning

confidence: 99%

Combined injuries in the upper cervical spine: clinical and epidemiological data over a 14-year period

Gleizes

Jacquot

Signoret

et al. 2000

European Spine Journal

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“…Atlantoaxial transarticular screw fixation, first introduced by Magerl and Seemann [13], has proved to be one of the most reliable, stable fixation techniques for treating atlantoaxial subluxation [7,16]. However, this operation has its own risks, notably one of which is an intraoperative injury to the vertebral artery [17,18].…”

Section: Introductionmentioning

confidence: 99%

Subaxial subluxation after atlantoaxial transarticular screw fixation in rheumatoid patients

et al. 2009

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The most common cervical abnormality associated with rheumatoid arthritis (RA) is atlantoaxial subluxation, and atlantoaxial transarticular screw fixation has proved to be one of the most reliable, stable fixation techniques for treating atlantoaxial subluxation. Following C1-C2 fixation, however, subaxial subluxation reportedly can bring about neurological deterioration and require secondary operative interventions. Rheumatoid patients appear to have a higher risk, but there has been no systematic comparison between rheumatoid and nonrheumatoid patients. Contributing radiological factors to the subluxation have also not been evaluated. The objective of this study was to evaluate subaxial subluxation after atlantoaxial transarticular screw fixation in patients with and without RA and to find contributing factors. Fortythree patients who submitted to atlantoaxial transarticular screw fixation without any concomitant operation were followed up for more than 1 year. Subaxial subluxation and related radiological factors were evaluated by functional X-ray measurements. Statistical analyses showed that aggravations of subluxation of 2.5 mm or greater were more likely to occur in RA patients than in non-RA patients over an average of 4.2 years of follow-up, and postoperative subluxation occurred in the anterior direction in the upper cervical spine. X-ray evaluations revealed that such patients had a significantly smaller postoperative C2-C7 angle, and that the postoperative AA angle correlated negatively with this. Furthermore, anterior subluxation aggravation was significantly correlated with the perioperative atlantoaxial and C2-C7 angle changes, and these two changes were strongly correlated to each other. In conclusion, after atlantoaxial transarticular screw fixation, rheumatoid patients have a greater risk of developing subaxial subluxations. The increase of the atlantoaxial angel at the operation can lead to a decrease in the C2-C7 angle, followed by anterior subluxation of the upper cervical spine and possibly neurological deterioration.

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Stable Posterior Fusion of the Atlas and Axis by Transarticular Screw Fixation

Cited by 517 publications

References 4 publications

Computer-assisted screw insertion for cervical disorders in rheumatoid arthritis

Computer-assisted screw insertion for cervical disorders in rheumatoid arthritis

Combined injuries in the upper cervical spine: clinical and epidemiological data over a 14-year period

Subaxial subluxation after atlantoaxial transarticular screw fixation in rheumatoid patients

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