European Spine Journal

, Volume 23, Issue 10, pp 2182–2188 | Cite as

Free-hand placement of occipital condyle screws: a cadaveric study

  • Mohamed Ali El-Gaidi
  • Ehab Mohamed Eissa
  • Ehab A. A. El-Shaarawy
Original Article
First Online:
Received:
Revised:
Accepted:

Abstract

Purpose

Cranio-vertebral junction fixation is challenging due to the complex topographical anatomy and the presence of important anatomical structures. There are several limitations to the traditional occipital squama fixation methods. The purpose of this work is to assess the safety and feasibility of a new optimum trajectory of occipital condyle (OC) screws for occipitocervical fixation via a free-hand technique.

Methods

Eight different parameters of OC morphology were studied in fifty adult skulls. Free-hand placement of OC screws was performed in five cadavers using 3.5-mm titanium polyaxial screws and a 3-mm rod construct (C0–C1–C2). Postoperative computed tomography was performed to determine the success of the screw placement and their angulation, length and effect on hypoglossal canal volume.

Results

The average length, width and height of the OC were 24.2 ± 3.6, 14.2 ± 1.9, and 10.7 ± 2 mm, respectively. The average medio-lateral, hypoglossal canal and atlanto-occipital joint angles were 38.8° medially ±5°, 7.4° rostrally ±1.9° and 23.4° caudally ±3.5°, respectively. The ten screws were successfully inserted using a free-hand technique with bicortical purchase. There was no vertebral artery injury or breach of the hypoglossal canal in any specimen. The average screw length was 22.2 ± 3.9 mm. The average medio-lateral angle was 30° medially ±6.7°. The average cranio-caudal angle was 4° caudally ±6.2°.

Conclusions

The free-hand technique of OC screw placement is a safe and viable option for occipitocervical fixation and may be a preferred alternative in selected cases. However, further studies are needed to compare its safety and reliability to other more established methods.

Keywords

Cranio-vertebral junction Occipitocervical fixation Occipital condyle screws Optimum trajectory 
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Notes

Conflict of interest

There are no competing interests, and this study did not receive any funds. No benefits in any form have been or will be received from any commercial party directly or indirectly related to the subject of this manuscript.

References

  1. 1.
    Abumi K, Takada T, Shono Y, Kaneda K, Fujiya M (1999) Posterior occipitocervical reconstruction using cervical pedicle screws and plate-rod systems. Spine 24:1425–1434PubMedCrossRefGoogle Scholar
  2. 2.
    Al-Mefty O, Borba LA, Aoki N, Angtuaoco E, Pait TG (1996) The transcondylar approach to extradural nonneoplastic lesions of the craniovertebral junction. J Neurosurg 84:1–6PubMedCrossRefGoogle Scholar
  3. 3.
    Bekelis K, Duhaime AC, Missios S, Belden C, Simmons N (2010) Placement of occipital condyle screws for occipitocervical fixation in a pediatric patient with occipitocervical instability after decompression for Chiari malformation. J Neurosurg Pediatr 6:171–176PubMedCrossRefGoogle Scholar
  4. 4.
    Ding X, Abumi K, Ito M, Sudo H, Takahata M, Nagahama K, Iwata A (2012) A retrospective study of congenital osseous anomalies at the craniocervical junction treated by occipitocervical plate-rod systems. Eur Spine J 21(8):1580–1589PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    de Oliveira E, Rhoton AL Jr, Peace D (1985) Microsurgical anatomy of the region of the foramen magnum. Surg Neurol 24:293–352PubMedCrossRefGoogle Scholar
  6. 6.
    Frankel BM, Hanley M, Vandergrift A, Monroe T, Morgan S, Rumboldt Z (2010) Posterior occipitocervical (C0-3) fusion using polyaxial occipital condyle to cervical spine screw and rod fixation: a radiographic and cadaveric analysis. J Neurosurg Spine 12(5):509–516PubMedCrossRefGoogle Scholar
  7. 7.
    Grob D, Dvorak J, Panjabi M, Froehlich M, Hayek J (1991) Posterior occipitocervical fusion. A preliminary report of a new technique. Spine 16:S17–S24PubMedCrossRefGoogle Scholar
  8. 8.
    Helgeson MD, Lehman RA Jr, Sasso RC, Dmitriev AE, Mack AW, Riew KD (2011) Biomechanical analysis of occipitocervical stability afforded by three fixation techniques. Spine J 11(3):245–250PubMedCrossRefGoogle Scholar
  9. 9.
    Karasu A, Cansever T, Batay F, Sabanci PA, Al-Mefty O (2009) The microsurgical anatomy of the hypoglossal canal. Surg Radiol Anat 31:363–367PubMedCrossRefGoogle Scholar
  10. 10.
    Kosnik-Infinger L, Glazier SS, Frankel BM (2014) Occipital condyle to cervical spine fixation in the pediatric population. J Neurosurg Pediatr 13:45–53PubMedCrossRefGoogle Scholar
  11. 11.
    la Marca F, Zubay G, Morrison T, Karahalios D (2008) Cadaveric study for placement of occipital condyle screws: technique and effects on surrounding anatomic structures. J Neurosurg Spine 9(4):347–353PubMedCrossRefGoogle Scholar
  12. 12.
    Le TV, Vivas AC, Baaj AA, Vale FL, Uribe JS (2014) Optimal trajectory for the occipital condyle screw. J Spinal Disord Tech 27:93–97Google Scholar
  13. 13.
    Lin SL, Xia DD, Chen W, Li Y, Shen ZH, Wang XY, Xu HZ, Chi YL (2014) Computed tomographic morphometric analysis of the pediatric occipital condyle for occipital condyle screw placement. Spine (Phila Pa 1976) 39(3):E147–E152CrossRefGoogle Scholar
  14. 14.
    Muthukumar N, Swaminathan R, Venkatesh G, Bhanumathy SP (2005) A morphometric analysis of the foramen magnum region as it relates to the transcondylar approach. Acta Neurochir (Wien) 147(8):889–895CrossRefGoogle Scholar
  15. 15.
    Naderi S, Korman E, Citak G, Güvencer M, Arman C, lu Seno M, Tetik S, Arda MN (2005) Morphometric analysis of human occipital condyle. Clin Neurol Neurosurg 107:191–199PubMedCrossRefGoogle Scholar
  16. 16.
    Nadim Y, Lu J, Sabry FF, Ebraheim N (2000) Occipital screws in occipitocervical fusion and their relation to the venous sinuses: an anatomic and radiographic study. Orthopedics 23:717–719PubMedGoogle Scholar
  17. 17.
    Ozer MA, Celik S, Govsa F, Ulusoy MO (2011) Anatomical determination of a safe entry point for occipital condyle screw using three-dimensional landmarks. Eur Spine J 20:1510–1517PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Pait TG, Al-Mefty O, Boop FA, Arnautovic KI, Rahman S, Ceola W (1999) Inside-outside technique for occipitocervical spine instrumentation and stabilization: preliminary results. J Neurosurg 90(1 Suppl):1–7PubMedGoogle Scholar
  19. 19.
    Randazzo CG, LeBude B, Ratliff J, Harrop J (2010) Occiput–cervical fixation. In: Patel VV et al (eds) Spine Trauma. Springer-Verlag, Berlin, Heidelberg, pp 119–127CrossRefGoogle Scholar
  20. 20.
    Sonntag VK, Dickman CA (1995) Occipitocervical instrumentation. In: Hitchon PW, Traynelis VC, Rengachary SS (eds) Techniques in spinal fusion and stabilization. Thieme, New York, pp 107–121Google Scholar
  21. 21.
    Suchomel P, Choutka O, Barsa P (2011) Surgical anatomy. In: Suchomel P, Choutka O (eds) Reconstruction of upper cervical spine and craniovertebral junction. Springer-Verlag, Berlin, Heidelberg, pp 3–15CrossRefGoogle Scholar
  22. 22.
    Takigawa T, Simon P, Espinoza Orías AA, Hong JT, Ito Y, Inoue N, An HS (2012) Biomechanical comparison of occiput-C1-C2 fixation techniques: C0–C1 transarticular screw and direct occiput condyle screw. Spine (Phila Pa 1976) 37(12):E696–E701CrossRefGoogle Scholar
  23. 23.
    Uribe JS, Ramos E, Vale F (2008) Feasibility of occipital condyle screw placement for occipitocervical fixation: a cadaveric study and description of a novel technique. J Spinal Disord Tech 21(8):540–546PubMedCrossRefGoogle Scholar
  24. 24.
    Uribe JS, Ramos E, Youssef AS, Levine N, Turner AW, Johnson WM, Vale FL (2010) Craniocervical fixation with occipital condyle screws: biomechanical analysis of a novel technique. Spine (Phila Pa 1976) 35(9):931–938CrossRefGoogle Scholar
  25. 25.
    Wen HT, Rhoton AL Jr, Katsuta T, de Oliveira E (1997) Microsurgical anatomy of the transcondylar, supracondylar, and paracondylar extensions of the far-lateral approach. J Neurosurg 87:555–585PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Mohamed Ali El-Gaidi
    • 1
  • Ehab Mohamed Eissa
    • 1
  • Ehab A. A. El-Shaarawy
    • 2
  1. 1.Department of Neurosurgery, Faculty of MedicineKasr Al-Aini Medical School, Cairo UniversityCairoEgypt
  2. 2.Department of Anatomy and Embryology, Faculty of MedicineKasr Al-Aini Medical School, Cairo UniversityCairoEgypt

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