Acta Neurochirurgica

, Volume 129, Issue 1–2, pp 47–53 | Cite as

Plate and screw fixation for atlanto-axial subluxation

  • A. Goel
  • V. Laheri
Clinical Articles

Summary

Our experience with 30 cases of atlanto-axial dislocation, over the period of 3 years and 9 months, is described. A modified plate and screw method of fixation of the lateral masses of the atlas and axis was successfully used in these cases. The technical aspects and merits of the method, wherein a 100% union rate was achieved, with no morbidity, mortality, or instrument fatigue or failure, are presented. The average follow-up period is of 19 months. The technique provided immediate rigid segmental internal fixation, permitting early mobilization with minimal external support. Onlay and interfacetal bone grafts subsequently produced bony fusion. Direct application of screws to the atlas and axis, thus utilizing the firm purchase in their thick and large cortico-cancellous lateral mass, provides a biomechanically strong fixation of the region.

Occipito-cervical fusion can be achieved in selected cases by a modification of the method. It appears that such a method of fixation could be useful at least in some complex congenital or traumatic craniovertebral region instability where the conventional methods have failed or are not suitable.

Keywords

Spinal fusion cranio-cervical instability atlanto-axial dislocation atlas axis 

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References

  1. 1.
    Alexander E Jr, Davis CH Jr (1969) Reduction and fusion of fracture of the odontoid process. J Neurosurg 31: 580–582PubMedGoogle Scholar
  2. 2.
    Aldrich EF, Crow WN, Weber PB, Spagnolia TN (1991) Use of MR imaging-compatible Halifax interlaminar clamps for posterior cervical fusion. J Neurosurg 74: 185–189PubMedGoogle Scholar
  3. 3.
    Aprin H, Harf R (1988) Stabilization of atlantoaxial instability. Orthopaedics 11: 1687–1693Google Scholar
  4. 4.
    Apuzzo MLJ, Heiden JS, Weiss MH (1978) Acute fractures of the odontoid process. An analysis of 45 cases. J Neurosurg 48: 85–91PubMedGoogle Scholar
  5. 5.
    Barbour JR (1971) Screw fixation and fractures of the odontoid process. S Australian Clin 5: 20–24Google Scholar
  6. 6.
    Bertrand G (1982) Anomalies of the craniovertebral junction. In: Youmans JR (ed) Neurological surgery: a comprehensive reference guide to the diagnosis and management of neurosurgical problems, 2nd Ed, Vol 3. Saunders, Philadelphia, p 1496Google Scholar
  7. 7.
    Bryan WJ, Inglis AE, Sculo TP, Ranawat CS (1982) Methylmethacrylate stabilization for enhancement of posterior cervical arthrodesis in rheumatoid arthritis. J Bone Joint Surg (Am) 64(A): 1045–1050Google Scholar
  8. 8.
    Clark CR, White AA III (1985) Fractures of the dens. A multicenter study. J Bone Joint Surg (Am) 67: 1340–1348Google Scholar
  9. 9.
    Cybulski GR, Stone JL, Crowell RM, Rifai MH, Gandhi Y, Glick R (1988) Use of Halifax interlaminar clamps for posterior C1-C2 arthrodesis. Neurosurgery 22: 429–431PubMedGoogle Scholar
  10. 10.
    Dickman CA, Sonntag VK, Papadopolous SM (1991) The interspinous method of posterior atlantoaxial arthodesis. J Neurosurg 74: 190–198PubMedGoogle Scholar
  11. 11.
    Dove J (1986) Internal fixation of the lumbar spine: the Hartshill rectangle. Clin Orthop 203: 135–140PubMedGoogle Scholar
  12. 12.
    Du Toit G (1978) Lateral atlanto-axial arthrodesis. A screw fixation technique. S African J Surg 14: 9–12Google Scholar
  13. 13.
    Fang HSY, Ong GB, Hodgson AR (1964) Anterior spinal fusion: the operative approaches. Clin Orthop 35: 16–33PubMedGoogle Scholar
  14. 14.
    Fang HSY, Ong GB (1962) Direct anterior approach to the upper cervical spine. J Bone Joint Surg (Am) 44 A: 1588–1604Google Scholar
  15. 15.
    Flint GA, Hockley AD, McMillan JJ, Thompson AG (1987) A new method of occipitocervical fusion using internal fixation. Neurosurgery 21: 947–950PubMedGoogle Scholar
  16. 16.
    Gallie WE (1939) Fractures and dislocations of the upper cervical spine. Am J Surg 46: 495–499Google Scholar
  17. 17.
    Geremia GK, Kim KS, Cerullo L, Calenoff L (1985) Complications of sublaminar wiring. Surg Neurol 23: 629–634PubMedGoogle Scholar
  18. 18.
    Goel VK, Winterbottom JM (1990) Ligamentous laxity across C0-C1-C2 complex. Spine 15: 339–342Google Scholar
  19. 19.
    Grob D, Magerl F (1987) Operative Stabilisierung bei Frakturen von C1 und C2. OrthopÄde 16: 46–54Google Scholar
  20. 20.
    Jackson H (1950) The diagnosis of minimal atlanto-axial subluxation. Br J Radiol 23: 672–674PubMedGoogle Scholar
  21. 21.
    Kelly DL, Alexander E, Davis CH, Smith JM (1972) Acrylic fixation of atlantoaxial dislocation. J Neurosurg 36: 366–371PubMedGoogle Scholar
  22. 22.
    Heywood AWB, Learmonth ID, Thomas M (1988) Internal fixation for occipito-cervical fusion. J Bone Joint Surg (Br) 70(B): 708–711Google Scholar
  23. 23.
    Holness RO, Heustis WS, Howes WJ, Langille RA (1984) Posterior stabilization with an interlaminar clamp in cervical injuries. technical note review of the long term experience with the method. Neurosurgery 14: 318–322PubMedGoogle Scholar
  24. 24.
    Kowada M, Takahashi M, Gito Y, Kishikawa T (1973) Fenestration of the vertebral artery: report of 2 angiographically demonstrated cases. Neuroradiology 6: 110–112PubMedGoogle Scholar
  25. 25.
    Lesoin F, Autricque A, Franz K, Villette L, Jomin M (1987) Transcervical approach and screw fixation for upper cervical spine pathology. Surg Neurol 27: 459–465PubMedGoogle Scholar
  26. 26.
    Lipson SJ, Hammerschlag SB (1984) Atlantoaxial arthrodesis in the presence of posterior spondyloschisis (bifid arch) of the atals: a report of three cases and an evaluation of alternative wiring techniques by computerized tomography. Spine 9: 65–69PubMedGoogle Scholar
  27. 27.
    Luque ER (1982) The anatomic basis and development of segmental spinal instrumentation. Spine 7: 256–259PubMedGoogle Scholar
  28. 28.
    McGraw RW, Rusch RM (1973) Atlanto-axial arthrodesis. J Bone Joint Surg (Br) 55 B: 482–489Google Scholar
  29. 29.
    Magerl F, Seeman P (1986) Stable fusion at atlas and axis by transarticular screw fixation. In: Kehr P, Weidner A (eds) Cervical spine, Strassburg 1985. Springer, Wien New YorkGoogle Scholar
  30. 30.
    McCarron RF, Robertson WW (1988) Brooks fusion for atlantoaxial instability in rheumatoid arthritis. South Med J 81: 474–476PubMedGoogle Scholar
  31. 31.
    Mixter SJ, Osgood RB (1910) Traumatic lesions of the atlas and axis. Ann Surg 51: 193–207Google Scholar
  32. 32.
    Newton TH, Mani RL (1974) The vertebral artery. In: Newton TH, Potts DG (eds) Radiology of the skull and brain. CV Mosby, Saint Louis, pp 1659–1709Google Scholar
  33. 33.
    Newman P, Sweetnam R (1969) Occipito-cervical fusion: an operative technique and its indications. J Bone Joint Surg (Br) 51 B: 423–431Google Scholar
  34. 34.
    Ransford AO, Crockard HA, Pozo JL, Thomas NP, Nelson IW (1986) Cervical instability treated by contoured loop fixation. J Bone Joint Surg (Br) 68: 173–177Google Scholar
  35. 35.
    Roy Camille R, Saillant G, Judet T, Mamoudi P, Feron JM (1982) Lateral atlanto-axial arthrodesis. Rev Chir Orthop 68: 139–142PubMedGoogle Scholar
  36. 36.
    Simmons EH (1982) Alternatives in the surgical stabilization of the upper cervical spine injuries. In: Tator CH (ed) Early management of acute spinal cord injury. Raven New York, pp 393–433Google Scholar
  37. 37.
    Sonntag VKH, Hadley MN (1988) Non-operative management of cervical spine injuries. Clin Neurosurg 34: 630–649PubMedGoogle Scholar
  38. 38.
    Sypert GW (1987) External spinal orthotics. Neurosurgery 20: 642–649PubMedGoogle Scholar
  39. 39.
    Takahashi M, Kawanami H, Watanabe N, Matsuoka S (1970) Fenestration of the extracranial vertebral artery. Radiology 96: 359–360PubMedGoogle Scholar
  40. 40.
    Teal JS, Rambaugh CL, Bergeron RT, Segall HD (1973) Angiographic demonstration of fenestrations of intradural intracranial arteries. Radiology 106: 123–126PubMedGoogle Scholar
  41. 41.
    VanGilder JC, Menezes AH, Dolan KD (1987) Radiology of asymptomatic craniovertebral anomalies. In: VanGilder JC, Menezes AH, Dolan KD (eds) The craniovertebral junction and its abnormalities. Futura, New York, pp 69–98Google Scholar
  42. 42.
    White AA, Panjabi MM (1983) Clinical biomechanics of the spine. Lippincott, Philadelphia, pp 54–61Google Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • A. Goel
    • 1
  • V. Laheri
    • 2
  1. 1.Department of NeurosurgerySeth G.S. Medical College and K.E.M. HospitalParel, BombayIndia
  2. 2.Department of OrthopaedicsSeth G.S. Medical College and K.E.M. HospitalParel, BombayIndia

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