nach oben

Acta Neurochirurgica

Erschienen in:

01.02.2012 | Clinical Article

Posterior C1-2 fusion with C1 lateral mass and C2 isthmic screws: accuracy of screw position, alignment and patient outcome

verfasst von: Florian Ringel, Andreas Reinke, Carsten Stüer, Bernhard Meyer, Michael Stoffel

Erschienen in: Acta Neurochirurgica | Ausgabe 2/2012

Einloggen, um Zugang zu erhalten

Abstract

Background

Transarticular screw fixation is seen as the “gold standard” in instrumented fusion of C1 and C2. However, drawbacks are the necessity of a reduction before instrumentation and a risk of vertebral artery injury. Therefore, C1 lateral mass and C2 isthmic screws are an alternative. The present study assessed the feasibility of C1-2 stabilization with C1 lateral mass and C2 isthmic screws and evaluated quality of life.

Method

All data of 35 consecutive patients treated from May 2006 to September 2009 were collected. Patients had C1 lateral mass and C2 isthmic screws.

Results

Twenty patients were operated on for traumatic instabilities, six for neoplastic instabilities, five for infectious instabilities and two each for degenerative and congenital instabilities. Sixty-six of 70 C1 screws had an ideal position, while four were placed suboptimal without the need for revision. Twelve of 68 C2 screws were not ideal but acceptable; one screw needed a surgical revision. There was one non-surgery related case of neurological deterioration after multilevel instrumentation. No vascular injuries occurred. Realignment was correct in all patients. After a median follow-up of 12 months, patients showed a reduction of pain, disability and improvements in EQ-5D items. SF36 data compared with a normative population and a historical cohort showed lower levels of function in all domains.

Conclusion

C1-C2 instrumented fusion with lateral mass and isthmic screws is a safe procedure. Sufficient screw position and alignment was possible in all cases. Therefore, at our institution transarticular screws were abandoned in favor of C1 lateral mass and C2 isthmic screws.

Aryan HE, Newman CB, Nottmeier EW, Acosta FL Jr, Wang VY, Ames CP (2008) Stabilization of the atlantoaxial complex via C-1 lateral mass and C-2 pedicle screw fixation in a multicenter clinical experience in 102 patients: modification of the Harms and Goel techniques. J Neurosurg Spine 8:222–229PubMedCrossRef

Brooks AL, Jenkins EB (1978) Atlanto-axial arthrodesis by the wedge compression method. J Bone Joint Surg Am 60:279–284PubMed

Bullinger M, Kirchberger I (1998) SF-36 Fragebogen zum Gesundheitszustand. Hogrefe, Göttingen Bern Toronto Seattle

Coric D, Branch CL Jr, Wilson JA, Robinson JC (1996) Arteriovenous fistula as a complication of C1-2 transarticular screw fixation. Case report and review of the literature. J Neurosurg 85:340–343PubMedCrossRef

Coyne TJ, Fehlings MG, Wallace MC, Bernstein M, Tator CH (1995) C1-C2 posterior cervical fusion: long-term evaluation of results and efficacy. Neurosurgery 37:688–692, discussion 692–683PubMedCrossRef

EuroQol (1990) EuroQol—a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy 16:199–208

Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66:271–273PubMed

Gallie W (1939) Fractures and dislocations of the cervical spine. Am J Surg 46:495–499CrossRef

Goel A, Desai KI, Muzumdar DP (2002) Atlantoaxial fixation using plate and screw method: a report of 160 treated patients. Neurosurgery 51:1351–1356, discussion 1356–1357PubMed

10.

Goel A, Laheri V (1994) Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir (Wien) 129:47–53CrossRef

11.

Gunnarsson T, Massicotte EM, Govender PV, Raja Rampersaud Y, Fehlings MG (2007) The use of C1 lateral mass screws in complex cervical spine surgery: indications, techniques, and outcome in a prospective consecutive series of 25 cases. J Spinal Disord Tech 20:308–316PubMedCrossRef

12.

Harms J, Melcher RP (2001) Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976) 26:2467–2471CrossRef

13.

Henriques T, Cunningham BW, Olerud C, Shimamoto N, Lee GA, Larsson S, McAfee PA (2000) Biomechanical comparison of five different atlantoaxial posterior fixation techniques. Spine (Phila Pa 1976) 25:2877–2883CrossRef

14.

Hong X, Dong Y, Yunbing C, Qingshui Y, Shizheng Z, Jingfa L (2004) Posterior screw placement on the lateral mass of atlas: an anatomic study. Spine (Phila Pa 1976) 29:500–503CrossRef

15.

Hott JS, Lynch JJ, Chamberlain RH, Sonntag VK, Crawford NR (2005) Biomechanical comparison of C1-2 posterior fixation techniques. J Neurosurg Spine 2:175–181PubMedCrossRef

16.

Koller H, Acosta F, Forstner R, Zenner J, Resch H, Tauber M, Lederer S, Auffarth A, Hitzl W (2009) C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes. Eur Spine J 18:1135–1153PubMedCrossRef

17.

Konig HH, Bernert S, Angermeyer MC (2005) Health Status of the German population: results of a representative survey using the EuroQol questionnaire. Gesundheitswesen 67:173–182PubMedCrossRef

18.

Kuroki H, Rengachary SS, Goel VK, Holekamp SA, Pitkanen V, Ebraheim NA (2005) Biomechanical comparison of two stabilization techniques of the atlantoaxial joints: transarticular screw fixation versus screw and rod fixation. Neurosurgery 56:151–159, discussion 151–159PubMedCrossRef

19.

Lapsiwala SB, Anderson PA, Oza A, Resnick DK (2006) Biomechanical comparison of four C1 to C2 rigid fixative techniques: anterior transarticular, posterior transarticular, C1 to C2 pedicle, and C1 to C2 intralaminar screws. Neurosurgery 58:516–521, discussion 516–521PubMed

20.

Madawi AA, Casey AT, Solanki GA, Tuite G, Veres R, Crockard HA (1997) Radiological and anatomical evaluation of the atlantoaxial transarticular screw fixation technique. J Neurosurg 86:961–968PubMedCrossRef

21.

Madawi AA, Solanki G, Casey AT, Crockard HA (1997) Variation of the groove in the axis vertebra for the vertebral artery. Implications for instrumentation. J Bone Joint Surg Br 79:820–823PubMedCrossRef

22.

Magerl F, Seemann PS (1987) Stable posterior fusion at the atlas and axis by transarticular screw fixation. In: Kehr P, Weidner A (eds) Cervical spine I. Springer, Wien, pp 322–327

23.

Mandel IM, Kambach BJ, Petersilge CA, Johnstone B, Yoo JU (2000) Morphologic considerations of C2 isthmus dimensions for the placement of transarticular screws. Spine (Phila Pa 1976) 25:1542–1547CrossRef

24.

Melcher RP, Puttlitz CM, Kleinstueck FS, Lotz JC, Harms J, Bradford DS (2002) Biomechanical testing of posterior atlantoaxial fixation techniques. Spine (Phila Pa 1976) 27:2435–2440CrossRef

25.

Mitchell TC, Sadasivan KK, Ogden AL, Mayeux RH, Mukherjee DP, Albright JA (1999) Biomechanical study of atlantoaxial arthrodesis: transarticular screw fixation versus modified Brooks posterior wiring. J Orthop Trauma 13:483–489PubMedCrossRef

26.

Naderi S, Crawford NR, Song GS, Sonntag VK, Dickman CA (1998) Biomechanical comparison of C1-C2 posterior fixations. Cable, graft, and screw combinations. Spine (Phila Pa 1976) 23:1946–1955, discussion 1955–1946CrossRef

27.

Paramore CG, Dickman CA, Sonntag VK (1996) The anatomical suitability of the C1-2 complex for transarticular screw fixation. J Neurosurg 85:221–224PubMedCrossRef

28.

Payer M, Luzi M, Tessitore E (2009) Posterior atlanto-axial fixation with polyaxial C1 lateral mass screws and C2 pars screws. Acta Neurochir (Wien) 151:223–229, discussion 229CrossRef

29.

Puttlitz CM, Melcher RP, Kleinstueck FS, Harms J, Bradford DS, Lotz JC (2004) Stability analysis of craniovertebral junction fixation techniques. J Bone Joint Surg Am 86-A:561–568PubMed

30.

Richter M, Schmidt R, Claes L, Puhl W, Wilke HJ (2002) Posterior atlantoaxial fixation: biomechanical in vitro comparison of six different techniques. Spine (Phila Pa 1976) 27:1724–1732CrossRef

31.

Richter M, Wilke HJ, Kluger P, Neller S, Claes L, Puhl W (2000) Biomechanical evaluation of a new modular rod-screw implant system for posterior instrumentation of the occipito-cervical spine: in-vitro comparison with two established implant systems. Eur Spine J 9:417–425PubMedCrossRef

32.

Richter M, Wilke HJ, Neller S, Claes L, Puhl W (2002) Neon–a new angle-stable implant system for dorsal occipitocervical instrumentation. Biomechanical comparison with established systems. Orthopade 31:346–355PubMedCrossRef

33.

Rocha R, Safavi-Abbasi S, Reis C, Theodore N, Bambakidis N, de Oliveira E, Sonntag VK, Crawford NR (2007) Working area, safety zones, and angles of approach for posterior C-1 lateral mass screw placement: a quantitative anatomical and morphometric evaluation. J Neurosurg Spine 6:247–254PubMedCrossRef

34.

Stoffel M, Behr M, Ringel F, Stuer C, Meyer B (2007) Posterior instrumentation of the cervical spine with a versatile modular fixation system. Zentralbl Neurochir 68:50–58PubMedCrossRef

35.

Stokes JK, Villavicencio AT, Liu PC, Bray RS, Johnson JP (2002) Posterior atlantoaxial stabilization: new alternative to C1-2 transarticular screws. Neurosurg Focus 12:E6PubMedCrossRef

36.

Stulik J, Vyskocil T, Sebesta P, Kryl J (2007) Atlantoaxial fixation using the polyaxial screw-rod system. Eur Spine J 16:479–484PubMedCrossRef

37.

Tan J, Li L, Sun G, Qian L, Yang M, Zeng C, Teng H, Jia L (2009) C1 lateral mass-C2 pedicle screws and crosslink compression fixation for unstable atlas fracture. Spine (Phila Pa 1976) 34:2505–2509CrossRef

38.

Wait SD, Ponce FA, Colle KO, Parry PV, Sonntag VK (2009) Importance of the C1 anterior tubercle depth and lateral mass geometry when placing C1 lateral mass screws. Neurosurgery 65:952–956, discussion 956–957PubMedCrossRef

39.

Wright NM, Lauryssen C (1998) Vertebral artery injury in C1-2 transarticular screw fixation: results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves. American Association of Neurological Surgeons/Congress of Neurological Surgeons. J Neurosurg 88:634–640PubMedCrossRef

40.

Yoshida M, Neo M, Fujibayashi S, Nakamura T (2006) Comparison of the anatomical risk for vertebral artery injury associated with the C2-pedicle screw and atlantoaxial transarticular screw. Spine 31:E513–E517PubMedCrossRef

Titel: Posterior C1-2 fusion with C1 lateral mass and C2 isthmic screws: accuracy of screw position, alignment and patient outcome
verfasst von: Florian Ringel
Andreas Reinke
Carsten Stüer
Bernhard Meyer
Michael Stoffel
Publikationsdatum: 01.02.2012
Verlag: Springer Vienna
Erschienen in: Acta Neurochirurgica / Ausgabe 2/2012
Print ISSN: 0001-6268
Elektronische ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-011-1224-x

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Neurologie

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders gilt das offenbar für weibliche Kranke, wie eine Studie zeigt.

Akuter Schwindel: Wann lohnt sich eine MRT?

28.04.2024 Schwindel Nachrichten

Akuter Schwindel stellt oft eine diagnostische Herausforderung dar. Wie nützlich dabei eine MRT ist, hat eine Studie aus Finnland untersucht. Immerhin einer von sechs Patienten wurde mit akutem ischämischem Schlaganfall diagnostiziert.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Frühe Alzheimertherapie lohnt sich

25.04.2024 AAN-Jahrestagung 2024 Nachrichten

Ist die Tau-Last noch gering, scheint der Vorteil von Lecanemab besonders groß zu sein. Und beginnen Erkrankte verzögert mit der Behandlung, erreichen sie nicht mehr die kognitive Leistung wie bei einem früheren Start. Darauf deuten neue Analysen der Phase-3-Studie Clarity AD.

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Background

Method

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 2/2012

Spinal instrumentation salvage after surgical site infection post long-segment deformity correction

Radiation necrosis following treatment of high grade glioma—a review of the literature and current understanding

Prognostic factors and survival in a prospective cohort of patients with high-grade glioma treated with carmustine wafers or temozolomide on an intention-to-treat basis

Orbital solitary fibrous tumor: a clinicopathologic study of ten cases with long-term follow-up

Erratum to: The subdiaphragmatic cistern: historic and radioanatomic findings