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Anterior occipital condyle screw placement through the endonasal corridor: proof of concept study with cadaveric analysis

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Abstract

Purpose

Odontoidectomy for ventral compressive pathology may result in O-C1 and/or C1-2 instability. Same-stage endonasal C1-2 spinal fusion has been advocated to eliminate risks associated with separate-stage posterior approaches. While endonasal methods for C1 instrumentation and C1-2 trans-articular stabilization exist, no hypothetical construct for endonasal occipital instrumentation has been validated. We provide an anatomic description of anterior occipital condyle (AOC) screw endonasal placement as proof-of-concept for endonasal craniocervical stabilization.

Methods

Eight adult, injected cadaveric heads were studied for placing 16 AOC screws endonasally. Thin-cut CT was used for registration. After turning a standard inferior U-shaped nasopharyngeal flap endonasally, 4 mm × 22 mm AOC screws were placed with a 0° driver using neuronavigation. Post-placement CT scans were obtained to determine: site-of-entry, measured from the endonasal projection of the medial O-C1 joint; screw angulation in sagittal and axial planes, proximity to critical structures.

Results

Average site-of-entry was 6.88 mm lateral and 9.74 mm rostral to the medial O-C1 joint. Average angulation in the sagittal plane was 0.16° inferior to the palatal line. Average angulation in the axial plane was 23.97° lateral to midline. Average minimum screw distances from the jugular bulb and hypoglossal canal were 4.80 mm and 1.55 mm.

Conclusion

Endonasal placement of AOC screws is feasible using a 0° driver. Our measurements provide useful parameters to guide optimal placement. Given proximity of hypoglossal canal and jugular bulb, neuronavigation is recommended. Biomechanical studies will ultimately be necessary to evaluate the strength of AOC screws with plate-screw constructs utilizing endonasal C1 lateral mass or C1-2 trans-articular screws as inferior fixation points.

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Availability of data and material

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45229, USA

    Jonathan A. Forbes, Paolo Palmisciano, Ahmed E. Hussein, Dmytro Zhebrykov, Justin Gibson, Norberto Andaluz, Charles J. Prestigiacomo, Justin Virojanapa & Joseph S. Cheng

  2. University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Chitra Kumar & Dan McGough

  3. Department of Neurological Surgery, Centro Médico Nacional 20 de Noviembre, ISSSTE, Mexico City, Mexico

    Diego Mendez-Rosito

  4. Department of Otolaryngology and Head and Neck, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Ahmad R. Sedaghat & Katie M. Phillips

  5. Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA

    Theodore H. Schwartz

Authors
  1. Jonathan A. Forbes
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  2. Chitra Kumar
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  15. Joseph S. Cheng
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Contributions

All authors contributed to the study conception and design. The study was conceptualized and supervised by JAF and JC Material preparation, data collection and analysis were performed by CK, DM, PP, AEH, DZ, JG, NA, CJP, DMR, JV, KMP and THS The first draft of the manuscript was written by J.A.F. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jonathan A. Forbes.

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The authors have no relevant financial or non-financial interests to disclose.

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As this is a pilot cadaver study, ethics approval is not applicable.

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As this is a pilot cadaver study, consent to participate is not applicable.

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As this is a pilot cadaver study, consent for publication is not applicable.

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Forbes, J.A., Kumar, C., McGough, D. et al. Anterior occipital condyle screw placement through the endonasal corridor: proof of concept study with cadaveric analysis. Eur Spine J 32, 682–688 (2023). https://doi.org/10.1007/s00586-022-07520-4

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  • DOI: https://doi.org/10.1007/s00586-022-07520-4

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