J Korean Neurosurg Soc.  2012 Aug;52(2):120-125. 10.3340/jkns.2012.52.2.120.

Posterior Atalntoaxial Fusion with C1 Lateral Mass Screw and C2 Pedicle Screw Supplemented with Miniplate Fixation for Interlaminar Fusion : A Preliminary Report

Affiliations
  • 1Department of Neurosurgery, College of Medicine, Catholic University of Daegu, Daegu, Korea. daehkim@cu.ac.kr

Abstract


OBJECTIVE
To investigate the feasibility of C1 lateral mass screw and C2 pedicle screw with polyaxial screw and rod system supplemented with miniplate for interlaminar fusion to treat various atlantoaxial instabilities.
METHODS
After posterior atlantoaxial fixation with lateral mass screw in the atlas and pedicle screw in the axis, we used 2 miniplates to fixate interlaminar iliac bone graft instead of sublaminar wiring. We performed this procedure in thirteen patients who had atlantoaxial instabilities and retrospectively evaluated the bone fusion rate and complications.
RESULTS
By using this method, we have achieved excellent bone fusion comparing with the result of other methods without any complications related to this procedure.
CONCLUSION
C1 lateral mass screw and C2 pedicle screw with polyaxial screw and rod system supplemented with miniplate for interlaminar fusion may be an efficient alternative method to treat various atlantoaxial instabilities.

Keyword

Atalantoaxial stabilization; Cervical spine; Interlaminar fusion

MeSH Terms

Axis, Cervical Vertebra
Humans
Retrospective Studies
Transplants

Figure

  • Fig. 1 A : Preoperative plan for paramedian approach. 3-4 cm length incision was made 1.5-2 cm off to midline bilaterally. B : Tubular retractor and Quadrant of METRX system (Medtronics®) was used to dissect paravertebral musculature.

  • Fig. 2 A : Intraoperative picture of the procedure with paramedian approach. B : Intraoperative picture of the procedure with classical midline approach.

  • Fig. 3 Preoperative dynamic X-ray of case 1. Black arrow shows widen ADI when patient is flexed.

  • Fig. 4 Postoperative X-ray of case 1. Stapler mark shows the extent of paramedian incision.

  • Fig. 5 4.5 months after the operation of case 1. Notice solid bone fusion occurred between C1-C2 lamina.

  • Fig. 6 Preoperative MRI of case 2. White arrow shows type II odontoid process fracture. Bold white arrow shows transverse ligament injury.

  • Fig. 7 Postoperative X-ray of case 2. Stapler mark shows the extent of classical midline incision.


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