Skip to main content
SpringerLink
Log in

Novel unilateral C1 double screw and ipsilateral C2 pedicle screw placement combined with contralateral laminar screw–rod fixation for atlantoaxial instability

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To investigate the anatomical and biomechanical feasibility of the unilateral C1 double screw [pedicle screw (PS) + lateral mass screw (LMS)] and ipsilateral C2 PS combined with contralateral C2 laminar screw (LS)-rod fixation for atlantoaxial instability by comparison with traditional posterior fixation methods.

Methods

Fifteen sets of complete dry bony specimens of atlas were used for morphometric analysis. The working length, width and thickness of the C1 PSs and LMSs were manually measured. Ten fresh-frozen cervical spines (C0–C7) were used to complete the range of motion (ROM) testing in their intact condition, under destabilization and after stabilization by the following procedures: unilateral C1–C2 PS rod fixation (Group A), bilateral C1–C2 PS rod fixation (Group B), and unilateral C1 double screw and ipsilateral C2 PS combined with contralateral C2 LS rod fixation (Group C).

Results

The working thickness of the C1 PS was ≤ 3.5 mm in only one (1/15 = 6.7%) specimen. The other parameters were > 3.5 mm in all specimens. In the ROM test, all fixation groups showed significantly reduced flexibility in all directions compared with both the intact and destabilization groups. Further, Groups B and C showed better stability in all directions than Group A. However, no significant differences were observed between Groups B and C.

Conclusion

The C1 unilateral lateral mass could mostly contain two screws(PS + LMS) with diameters ≤ 3.5 mm. The novel technique of unilateral C1 double screw and ipsilateral C2 PS combined with contralateral C2 LS rod fixation provided better stability than unilateral PS rod fixation and similar as bilateral PS rod fixation. Therefore, it is a feasible salvage method that provides a new insight into atlantoaxial instability.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Goel A, Laheri V (1994) Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir 129(1–2):47–53

    Article  CAS  PubMed  Google Scholar 

  2. Harms J, Melcher RP (2001) Posterior C1–C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976) 23(22):2467–2471

    Article  Google Scholar 

  3. Resnick DK, Benzel EC (2002) C1–C2 pedicle screw fixation with rigid cantilever beam construct: case report and technical note. Neurosurgery 50(2):426–428

    PubMed  Google Scholar 

  4. Fensky F, Kueny RA, Sellenschloh K et al (2014) Biomechanical advantage of C1 pedicle screws over C1 lateral mass screws: a cadaveric study. Eur Spine J 23(4):724–731

    Article  PubMed  Google Scholar 

  5. Eck JC, Walker MP, Currier BL, Chen Q, Yaszemski MJ, An KN (2007) Biomechanical comparison of unicortical versus bicortical C1 lateral mass screw fixation. J Spin Disord Tech 20(7):505–508

    Article  Google Scholar 

  6. Ma XY, Yin QS, Wu ZH et al (2009) C1 pedicle screws versus C1 lateral mass screws: comparisons of pullout strengths and biomechanical stabilities. Spine (Phila Pa 1976) 34(4):371–377

    Article  Google Scholar 

  7. 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(16):1724–1732

    Article  Google Scholar 

  8. Paik SC, Chun HJ, Bak KH, Ryu J, Choi KS (2015) Unilateral C1 Lateral Mass and C2 Pedicle Screw Fixation for Atlantoaxial Instability in Rheumatoid Arthritis Patients: Comparison with the Bilateral Method. J Korean Neurosurg Soc 57(6):460–464

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Bhatia N, Rama A, Sievers B et al (2017) Biomechanical evaluation of unilateral versus bilateral C1 lateral mass-C2 intralaminar fixation. Global Spine J 7(3):239–245

    Article  PubMed  PubMed Central  Google Scholar 

  10. Tan M, Wang H, Wang Y et al (2003) Morphometric evaluation of screw fixation in atlas via posterior arch and lateral mass. Spine (Phila Pa 1976) 28(9):888–895

    Google Scholar 

  11. Shen K, Deng Z, Yang J, Liu C, Zhang R (2017) Biomechanical study of novel unilateral C1 posterior arch screws and C2 laminar screws combined with an ipsilateral crossed C1–C2 pedicle screw-rod fixation for atlantoaxial instability. Arch Orthop Trauma Surg 137(10):1349–1355

    Article  PubMed  Google Scholar 

  12. Calisaneller T, Yilmaz C, Ozdemir O, Caner H (2008) Posterior atlantal lateral mass fixation technique with polyaxial screw and rod fixation system. Turkish Neurosurg 18(2):142–148

    Google Scholar 

  13. Chen JF, Wu CT, Lee SC, Lee ST (2005) Posterior atlantoaxial transpedicular screw and plate fixation. J Neurosurg Spine 2(3):386–392

    Article  PubMed  Google Scholar 

  14. Yoon KW, Ko JH, Cho CS, Lee SK, Kim YJ, Kim YJ (2013) Endovascular treatment of vertebral artery injury during cervical posterior fusion (C1 lateral mass screw). A case report. Interv Neuroradiol 19(3):370–376

    Article  PubMed  PubMed Central  Google Scholar 

  15. Lall R, Patel NJ, Resnick DK (2010) A review of complications associated with craniocervical fusion surgery. Neurosurgery 67(5):1396–1403

    Article  PubMed  Google Scholar 

  16. Wright NM (2004) Posterior C2 fixation using bilateral, crossing C2 laminar screws: case series and technical note. J Spinal Disord Tech 17(2):158–162

    Article  PubMed  Google Scholar 

  17. Du S, Ni B, Lu X et al (2017) Application of unilateral C2 translaminar screw in the treatment for atlantoaxial instability as an alternative or salvage of pedicle screw fixation. World Neurosurg 97:86–92

    Article  PubMed  Google Scholar 

  18. Christensen DM, Eastlack RK, Lynch JJ, Yaszemski MJ, Currier BL (2007) C1 anatomy and dimensions relative to lateral mass screw placement. Spine (Phila Pa 1976) 32(8):844–848

    Article  Google Scholar 

  19. Seal C, Zarro C, Gelb D, Ludwig S (2009) C1 lateral mass anatomy: Proper placement of lateral mass screws. J Spinal Disord Tech 22(7):516–523

    Article  PubMed  Google Scholar 

  20. Gupta T (2008) Cadaveric morphometric anatomy of C-1 vertebra in relation to lateral mass screw placement. Surg Radiol Anat 30(7):589–593

    Article  PubMed  Google Scholar 

  21. Simsek S, Yigitkanli K, Seçkin H et al (2009) Ideal screw entry point and projection angles for posterior lateral mass fixation of the atlas: an anatomical study. Eur Spine J 18(9):1321–1325

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ma XY, Yin QS, Wu ZH, Xia H, Liu JF, Zhong SZ (2007) Anatomic considerations for the pedicle screw placement in the first cervical vertebra. Spine (Phila Pa 1976) 30(13):1519–1523

    Article  Google Scholar 

  23. Lee MJ, Cassinelli E, Riew KD (2006) The feasibility of inserting atlas lateral mass screws via the posterior arch. Spine 31(24):2798–2801

    Article  PubMed  Google Scholar 

  24. Zhang XL, Huang DG, Wang XD et al (2017) The feasibility of inserting a C1 pedicle screw in patients with ponticulus posticus: a retrospective analysis of eleven patients. Eur Spine J 26(4):1058–1063

    Article  PubMed  Google Scholar 

Download references

Funding

The study was supported by the national nature science foundation of China (No. 81301573), natural science foundation of Chongqing (No. cstc2013jcyjA10090), the special foundation for social safeguard and scientific innovation of Chongqing (No. cstc2016shms-ztzx10001-6), Science and technology foundation of Yuzhong district in Chongqing (No. 20160131), Chongqing research and innovation project of graduate students(No.YB17112).

Author information

Author notes

  1. Lei Shi and Kai Shen these authors have contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, No. 76 Linjiang Road, Yuzhong District, Chongqing, 400010, People’s Republic of China

    Lei Shi, Kai Shen, Rui Deng, Zheng-Jian Yan, Kai-Lu Liang, Liang Chen, Zhen-Yong Ke & Zhong-Liang Deng

  2. Geriatric Clinical Research Center of Chongqing, Chongqing, People’s Republic of China

    Lei Shi, Zheng-Jian Yan, Kai-Lu Liang, Liang Chen, Zhen-Yong Ke & Zhong-Liang Deng

  3. Department of Orthopedics, Chongqing General Hospital, No. 312 Zhongshanyi Road, Yuzhong District, Chongqing, People’s Republic of China

    Kai Shen

Authors
  1. Lei Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kai Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rui Deng
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zheng-Jian Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kai-Lu Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Liang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zhen-Yong Ke
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Zhong-Liang Deng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zhong-Liang Deng.

Ethics declarations

Conflict of interest

All authors have declared that they have no conflicts of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 1090 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shi, L., Shen, K., Deng, R. et al. Novel unilateral C1 double screw and ipsilateral C2 pedicle screw placement combined with contralateral laminar screw–rod fixation for atlantoaxial instability. Eur Spine J 28, 362–369 (2019). https://doi.org/10.1007/s00586-018-5853-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-018-5853-0

Keywords

Search

Navigation