Abstract
C2 laminar screws have become an increasingly used alternative method to C2 pedicle screw fixation. However, the outcome of this technique has not been thoroughly investigated. A total of 35 cases with upper cervical spinal instability undergoing C2 laminar screw fixation were reviewed. All cases had symptoms of atlantoaxial instability, such as craniocervical junction pain, and were fixed with the Vertex cervical internal fixation system. A total of 68 screws were placed and hybrid constructs (a C2 translaminar screw combined with a C2 pars screw) were incorporated in two patients. In this series, there were no intraoperative complications and no cases of neurological worsening or vascular injury from hardware placement. Computed tomographic scans demonstrated a partial dorsal laminar breach in ten patients. None of these resulted in neurological symptoms. None of the patients was found to have a breach of the ventral laminar cortex. All the C2 laminar screws fixations were performed successfully. There was no instability seen on the films with no evidence of hardware failure or screw loosening during the follow-up period in all patients. In conclusion, C2 laminar screw technique is straightforward and easily adopted; it can efficiently and reliably restore upper cervical stability. It is an alternative method to C2 pedicle screw fixation, especially in patients with unilateral occlusion of vertebral artery and pedicle deformity of C2.
Similar content being viewed by others
References
Jeanneret B, Magerl F (1992) Primary posterior fusion C1/2 in odontoid fractures: indications, technique, and results of transarticular screw fixation. J Spinal Disord 5:464–475
Harms J, Melcher RP (2001) Posterior C1–C2 fusion with polyaxial screw and rod fixation. Spine 26:2467–2471
Reilly TM, Sasso RC, Hall PV (2003) Atlantoaxial stabilization: clinical comparison of posterior cervical wiring technique with transarticular screw fixation. J Spinal Disord Tech 16:248–253
Wright NM (2004) Posterior C2 fixation using bilateral, crossing C2 laminar screws: case series and technical note. J Spinal Disord Tech 17:158–162
Richter M, Schmidt R, Claes L, Puhl W, Wilke HJ (2002) Posterior atlantoaxial fixation: biomechanical in vitro comparison of six different techniques. Spine 27:1724–1732
Grob D, Crisco JJ III, Panjabi NM, Wang P, Dvorak J (1992) Biomechanical evaluation of four different posterior atlantoaxial fixation techniques. Spine 17:480–490
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 88:634–640. doi:103171/jns.1998.88.4.0634
Ebraheim N, Rollins JR Jr, Xu R, Jackson WT (1996) Anatomic consideration of C2 pedicle screw placement. Spine 21:691–695
Tan M, Wang H, Wang Y, Zhang G, Yi P, Li Z, Wei H, Yang F (2003) Morphometric evaluation of screw fixation in atlas via posterior arch and lateral mass. Spine 28:888–895
Roy-Camille R, Bouchet TH, Saillant G (1984) Fractures des predicles d l’axi.Journees d’orthopedie a la Pitie. Masson, Paris, pp 119–134
Igarashi T, Kikuchi S, Sato K, kayama S, Otani K (2003) Anatomic study of the axis for surgical planning of transarticular screw fixation. Clin Orthop Relat Res (408):162–166. doi:10.1097/01.bl0.0000048136.30533.4f
Gorek J, Acaroglu E, Berven S, Yousef A, Puttlitz CM (2005) Constructs incorporating intralaminar C2 screws provide rigid stability for atlantoaxial fixation. Spine 30:1513–1518. doi:10.1097/01.brs.0000167827.84020.49
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. doi:10.1227/01.neu.0000197222.05299.31
Cassinelli EH, Lee M, Skalak A, Ahn UN, Wright NM (2006) Anatomic considerations for the placement of C2 laminar screws. Spine 31:2767–2771. doi:10.1097/01.brs.0000245869.85276.f4
Wang MY (2007) Cervical crossing laminar screws: early clinical results and complications. Neurosurgery 61:311–316. doi:10.1227/01.neu.0000303987.49870.76
Matsubara T, Mizutani J, Fukuoka M, Hatoh T, Kojima H, Otsuka T (2007) Safe atlantoaxial fixation using a laminar screw (intralaminar screw) in a patient with unilateral occlusion of vertebral artery: case report. Spine 32:E30–E33. doi:10.1097/01.brs.0000250994.24462.ec
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ma, W., Feng, L., Xu, R. et al. Clinical application of C2 laminar screw technique. Eur Spine J 19, 1312–1317 (2010). https://doi.org/10.1007/s00586-010-1447-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-010-1447-1