Triple anterior screw fixation of an acute combination atlas—axis fracture

Apostolides, Paul J.; Theodore, Nicholas; Karahalios, Dean G.; Sonntag, Volker K. H.

doi:10.3171/jns.1997.87.1.0096

Cited by 50 publications

(40 citation statements)

References 28 publications

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“…Potential risks of this technique are damage to the vertebral artery (if screw trajectory is too lateral) and occipitocervical fusion (if screws are too long). 2 We used a 3.8 cm screw and did not find any complications.…”

Section: Discussionmentioning

confidence: 91%

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Minimally invasive technique of triple anterior screw fixation for an acute combination atlas–axis fracture: case report and literature review

et al. 2009

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Study design: A case report to describe the minimally invasive technique of treating C1-type II odontoid combination fractures. Objective: To introduce a new, minimally invasive technique of triple anterior screw fixation for acute combination atlas-axis fractures. Summary of background data: Management for C1-type II odontoid combination fractures includes traction, immobilization and posterior fusion with and without instrumentation and anterior odontoid screw fixation. The combination of odontoid and bilateral transarticular C1-C2 anterior screw fixation is a recent addition in treating C1-type II odontoid fractures. Methods: A case of combination atlas-type II odontoid fracture occurred in a 39-year-old man. Imaging examinations showed a fracture of the unilateral anterior and posterior arch of C1 associated with type II odontoid fracture and with significant prevertebral soft tissue edema. Treatment consisted of odontoid and bilateral C1-C2 transarticular screw fixation through bilateral anterior small incisions. Results: The patient was mobilized early postoperatively with a hard cervical collar and discharged 4 days later. On 2-year follow-up, he presented no cervical complaints and only mild reduction in neck rotation. Conclusion: In case of C1-type II odontoid fracture, the triple anterior screw fixation can be taken into consideration as an alternative because of its superiority of minimal invasion, stability and safety.

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Section: Discussionmentioning

confidence: 91%

“…There have been two reports of 92-and 85-year-old men with 'triple' anterior screw fixation technique. 1,2 We report the successful result obtained in a young patient affected by an acute combination atlas-type II odontoid fracture and treated with anterior odontoid and bilateral C1-C2 transarticular screw fixation.…”

Section: Introductionmentioning

confidence: 98%

Minimally invasive technique of triple anterior screw fixation for an acute combination atlas–axis fracture: case report and literature review

et al. 2009

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“…We detected a high incidence of C1/C2 combination injuries in 48%. For this reason we do not consider concomitant C1 fractures a ''complication'' [5,6] of the odontoid fracture, since this is rather commonplace in nearly 50% of this patient population.…”

Section: Discussionmentioning

confidence: 99%

Radiographic analysis of type II odontoid fractures in a geriatric patient population: description and pathomechanism of the “Geier”-deformity

et al. 2011

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Introduction Type II odontoid fractures are one among the most common cervical spine fractures in the elders. We reviewed a consecutive series of patients, aged 65 years and older, presenting to our institution with type II odontoid fractures. Our analysis focused on the radiographic outcome, union rate and the development of cervical spine postural deformity. Patients/methods Indications for surgical treatment (OP) included displaced or unstable injuries. Stable, nondisplaced injuries or patients with significant co-morbidities were treated nonoperatively (non-op). Results Ninety patients (50 f, 40 m) with an average age of 83 years (65-101) were identified. 31 (34.4%) patients were received OP and 57 (63.3%) were received non-op treatments. The hospital length of stay was significantly longer after OP (mean 10 days vs. 6 days non-op) treatment (p = 0.007). At follow-up, higher union rates were noted in the OP (76.2%) than in the non-op group (58.3%). Conclusion We observed a characteristic cervical spine deformity in geriatric patients with type II odontoid fractures, and have termed this the ''Geier-deformity''. Clinical findings of the deformity include sagittal imbalance and kyphosis of the lower cervical spine.

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“…It may also be used as a complementary option if previous posterior fixation and fusion have failed to provide adequate stability [1,18]. Furthermore, it may be a reasonable option in selected cases in polytrauma, respiratory-compromised [4], or hemodynamically vulnerable elderly patients [5,6], wherein a prone position may increase operative morbidity and/or mortality.…”

Section: Introductionmentioning

confidence: 99%

“…Anterior transarticular screw (ATAS) fixation across the atlantoaxial joint has been suggested as a viable alternative to posterior stabilization in the upper cervical spine [1][2][3][4][5][6][7][8][9][10]. Fixation through the anterior route may be advantageous in some patients requiring subsequent stabilization after anterior decompression because it obviates the need for additional posterior surgery [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Fluoroscopically guided anterior atlantoaxial transarticular screws: a feasibility and trajectory study using CT-based simulation software

et al. 2013

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BACKGROUND CONTEXT: Anterior transarticular screw (ATAS) fixation has been suggested as a viable alternative to posterior stabilization. However, we are not aware of previous reports attempting to establish the usefulness of specific fluoroscopic landmark-guided trajectories in the use of ATAS, and we could find no reference to it in a computerized search using MEDLINE. PURPOSE: To determine the anatomic feasibility of ATAS placement using defined fluoroscopic landmarks to guide screw trajectory. STUDY DESIGN: Evaluation using three-dimensional screw insertion simulation software and 1.0-mm-interval computed tomographic scans. PATIENT SAMPLE: Computed tomographic scans of 100 patients including 50 men and 50 women. OUTCOME MEASURES: Incidence of violation of the vertebral artery groove of C1 and C2, the spinal canal, and the atlanto-occipital joint and screw lengths and lengths of C1 and C2 purchase. METHODS: Four screw trajectories were determined: promontory screw (PS), single central facet (CF) screw, and medial (MF) and lateral (LF) double facet screws. Placement of a 4.0-mm screw was simulated using defined fluoroscopic landmarks for each trajectory. The previously mentioned outcome measures were evaluated and compared for the four trajectories. This study was not supported by any financial sources, and there is no topic-specific potential conflict of interest with this study. The disclosure key can be found on the CONCLUSIONS:Our results suggest that it may be possible to place ATASs without violating the vertebral artery groove, spinal canal, or the atlanto-occipital joint by using the described entry points, trajectories, and fluoroscopic landmarks. Ó

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Triple anterior screw fixation of an acute combination atlas—axis fracture

Cited by 50 publications

References 28 publications

Minimally invasive technique of triple anterior screw fixation for an acute combination atlas–axis fracture: case report and literature review

Minimally invasive technique of triple anterior screw fixation for an acute combination atlas–axis fracture: case report and literature review

Radiographic analysis of type II odontoid fractures in a geriatric patient population: description and pathomechanism of the “Geier”-deformity

Fluoroscopically guided anterior atlantoaxial transarticular screws: a feasibility and trajectory study using CT-based simulation software

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