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Atlantoaxial Stabilization

  • Avery L. Buchholz
  • John C. Quinn
  • Christopher I. ShaffreyEmail author
  • Justin S. Smith
Chapter

Abstract

Over the last few decades, atlantoaxial stabilization has evolved from simple posterior wiring techniques to a multitude of screw fixation points, trajectories, and constructs. Some of the earliest reports of C1 and C2 stabilization date back to 1910 when Mixter and Osgood described using heavy silk thread to tie the spinous processes together. Gallie reported on his use of C1–C2 fixation using wire in 1939. This was followed by further modifications described by Brooks and Jenkins in 1978 and Dickman and Sonntag in 1991. Interlaminar clamps were introduced in the 1980s along with C1 and C2 screw fixation techniques. These techniques have continued to evolve and will be discussed, along with the indications and variety of instrumentation options throughout this chapter.

Keywords

Atlantoaxial stabilization C1–C2 fixation C1–C2 stabilization Posterior wiring Clamp fixation Transarticular screws C1–C2 segmental fixation Translaminar screw Stand-alone C2 fixation Jefferson fracture C1 lateral mass screw 

References

  1. 1.
    Mixter SJ, Osgood RB. IV. Traumatic lesions of the atlas and axis. Ann Surg. 1910;51(2):193–207.CrossRefGoogle Scholar
  2. 2.
    Gallie WE. Fractures and dislocations of cervical spine. Am J Surg. 1939;46:495–9.CrossRefGoogle Scholar
  3. 3.
    Brooks AL, Jenkins EB. Atlanto-axial arthrodesis by the wedge compression method. J Bone Joint Surg. 1978;60(3):279–84.CrossRefGoogle Scholar
  4. 4.
    Dickman CA, Sonntag VK, Papadopoulos SM, Hadley MN. The interspinous method of posterior atlantoaxial arthrodesis. J Neurosurg. 1991;74(2):190–8.CrossRefGoogle Scholar
  5. 5.
    Holness RO, Huestis WS, Howes WJ, Langille RA. Posterior stabilization with an interlaminar clamp in cervical injuries: technical note and review of the long term experience with the method. Neurosurgery. 1984;14(3):318–22.CrossRefGoogle Scholar
  6. 6.
    Goel A, Desai KI, Muzumdar DP. Atlantoaxial fixation using plate and screw method: a report of 160 treated patients. Neurosurgery. 2002;51(6):1351–6; discussion 1356-1357.CrossRefGoogle Scholar
  7. 7.
    Coyne TJ, Fehlings MG, Wallace MC, Bernstein M, Tator CH. C1-C2 posterior cervical fusion: long-term evaluation of results and efficacy. Neurosurgery. 1995;37(4):688–92; discussion 692-683.CrossRefGoogle Scholar
  8. 8.
    McDonnell DEHS. Posterior atlantoaxial fusion: indications and techniques. In: Traynelis VCRS, editor. Techniques in spinal fusion and Stabialization. New York: Thiem; 1995. p. 92–106.Google Scholar
  9. 9.
    Huhn SL, Wolf AL, Ecklund J. Posterior spinal osteosynthesis for cervical fracture/dislocation using a flexible multistrand cable system: technical note. Neurosurgery. 1991;29(6):943–6.CrossRefGoogle Scholar
  10. 10.
    Vender JR, Rekito AJ, Harrison SJ, McDonnell DE. The evolution of posterior cervical and occipitocervical fusion and instrumentation. Neurosurg Focus. 2004;16(1):E9.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Vender JR, Houle PJ, Harrison S, McDonnell DE. Occipital-cervical fusion using the Locksley intersegmental tie bar technique: long-term experience with 19 patients. Spine J. 2002;2(2):134–41.CrossRefGoogle Scholar
  12. 12.
    Hanimoglu H, Hanci L, Kaynar MY, Hanci M. Bilateral C1-C2 claw for atlantoaxial instability. Turk Neurosurg. 2009;19(4):345–8.PubMedGoogle Scholar
  13. 13.
    Duff TA, Khan A, Corbett JE. Surgical stabilization of cervical spinal fractures using methyl methacrylate. Technical considerations and long-term results in 52 patients. J Neurosurg. 1992;76(3):440–3.CrossRefGoogle Scholar
  14. 14.
    Jeanneret B, Magerl F. Primary posterior fusion C1/2 in odontoid fractures: indications, technique, and results of transarticular screw fixation. J Spinal Disord. 1992;5(4):464–75.CrossRefGoogle Scholar
  15. 15.
    Mummaneni PV, Haid RW. Atlantoaxial fixation: overview of all techniques. Neurol India. 2005;53(4):408–15.CrossRefGoogle Scholar
  16. 16.
    Claybrooks R, Kayanja M, Milks R, Benzel E. Atlantoaxial fusion: a biomechanical analysis of two C1-C2 fusion techniques. Spine J. 2007;7(6):682–8.CrossRefGoogle Scholar
  17. 17.
    Elliott RE, Tanweer O, Boah A, et al. Atlantoaxial fusion with transarticular screws: meta-analysis and review of the literature. World Neurosurg. 2013;80(5):627–41.CrossRefGoogle Scholar
  18. 18.
    Ni B, Zhou F, Guo Q, Li S, Guo X, Xie N. Modified technique for C1-2 screw-rod fixation and fusion using autogenous bicortical iliac crest graft. Eur Spine J. 2012;21(1):156–64.CrossRefGoogle Scholar
  19. 19.
    Huang DG, Hao DJ, He BR, et al. Posterior atlantoaxial fixation: a review of all techniques. Spine J. 2015;15(10):2271–81.CrossRefGoogle Scholar
  20. 20.
    Goel A, Laheri V. Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir. 1994;129(1–2):47–53.CrossRefGoogle Scholar
  21. 21.
    Harms J, Melcher RP. Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine. 2001;26(22):2467–71.CrossRefGoogle Scholar
  22. 22.
    Gorek J, Acaroglu E, Berven S, Yousef A, Puttlitz CM. Constructs incorporating intralaminar C2 screws provide rigid stability for atlantoaxial fixation. Spine. 2005;30(13):1513–8.CrossRefGoogle Scholar
  23. 23.
    Lehman RA Jr, Dmitriev AE, Helgeson MD, Sasso RC, Kuklo TR, Riew KD. Salvage of C2 pedicle and pars screws using the intralaminar technique: a biomechanical analysis. Spine. 2008;33(9):960–5.CrossRefGoogle Scholar
  24. 24.
    Meyer D, Meyer F, Kretschmer T, Borm W. Translaminar screws of the axis--an alternative technique for rigid screw fixation in upper cervical spine instability. Neurosurg Rev. 2012;35(2):255–61; discussion 261.CrossRefGoogle Scholar
  25. 25.
    Wright NM. Posterior C2 fixation using bilateral, crossing C2 laminar screws: case series and technical note. J Spinal Disord Tech. 2004;17(2):158–62.CrossRefGoogle Scholar
  26. 26.
    Sciubba DM, Noggle JC, Vellimana AK, et al. Radiographic and clinical evaluation of free-hand placement of C-2 pedicle screws. Clinical article. J Neurosurg Spine. 2009;11(1):15–22.CrossRefGoogle Scholar
  27. 27.
    Lee SH, Kim ES, Sung JK, Park YM, Eoh W. Clinical and radiological comparison of treatment of atlantoaxial instability by posterior C1-C2 transarticular screw fixation or C1 lateral mass-C2 pedicle screw fixation. J Clin Neurosci. 2010;17(7):886–92.CrossRefGoogle Scholar
  28. 28.
    Liu G, Buchowski JM, Shen H, Yeom JS, Riew KD. The feasibility of microscope-assisted “free-hand” C1 lateral mass screw insertion without fluoroscopy. Spine. 2008;33(9):1042–9.CrossRefGoogle Scholar
  29. 29.
    Hamilton DK, Smith JS, Sansur CA, Dumont AS, Shaffrey CI. C-2 neurectomy during atlantoaxial instrumented fusion in the elderly: patient satisfaction and surgical outcome. J Neurosurg Spine. 2011;15(1):3–8.CrossRefGoogle Scholar
  30. 30.
    Resnick DK, Benzel EC. C1-C2 pedicle screw fixation with rigid cantilever beam construct: case report and technical note. Neurosurgery. 2002;50(2):426–8.PubMedGoogle Scholar
  31. 31.
    Lee SH, Kim ES, Eoh W. Modified C1 lateral mass screw insertion using a high entry point to avoid postoperative occipital neuralgia. J Clin Neurosci. 2013;20(1):162–7.CrossRefGoogle Scholar
  32. 32.
    Kelly BP, Glaser JA, DiAngelo DJ. Biomechanical comparison of a novel C1 posterior locking plate with the harms technique in a C1-C2 fixation model. Spine. 2008;33(24):E920–5.CrossRefGoogle Scholar
  33. 33.
    Reis MT, Nottmeier EW, Reyes PM, Baek S, Crawford NR. Biomechanical analysis of a novel hook-screw technique for C1-2 stabilization. J Neurosurg Spine. 2012;17(3):220–6.CrossRefGoogle Scholar
  34. 34.
    Parker SL, McGirt MJ, Garces-Ambrossi GL, et al. Translaminar versus pedicle screw fixation of C2: comparison of surgical morbidity and accuracy of 313 consecutive screws. Neurosurgery. 2009;64(5 Suppl 2):343–348; discussion 348-349.CrossRefGoogle Scholar
  35. 35.
    Borne GM, Bedou GL, Pinaudeau M. Treatment of pedicular fractures of the axis. A clinical study and screw fixation technique. J Neurosurg. 1984;60(1):88–93.CrossRefGoogle Scholar
  36. 36.
    Buchholz AL, Morgan SL, Robinson LC, Frankel BM. Minimally invasive percutaneous screw fixation of traumatic spondylolisthesis of the axis. J Neurosurg Spine. 2015;22(5):459–65.CrossRefGoogle Scholar
  37. 37.
    Jo KW, Park IS, Hong JT. Motion-preserving reduction and fixation of C1 Jefferson fracture using a C1 lateral mass screw construct. J Clin Neurosci. 2011;18(5):695–8.CrossRefGoogle Scholar
  38. 38.
    Goel A, Karapurkar AP. Transoral plate and screw fixation of the craniovertebral region--a preliminary report. Br J Neurosurg. 1994;8(6):743–5.CrossRefGoogle Scholar
  39. 39.
    Sawin PD, Traynelis VC, Menezes AH. A comparative analysis of fusion rates and donor-site morbidity for autogeneic rib and iliac crest bone grafts in posterior cervical fusions. J Neurosurg. 1998;88(2):255–65.CrossRefGoogle Scholar
  40. 40.
    Hood B, Hamilton DK, Smith JS, Dididze M, Shaffrey C, Levi AD. The use of allograft and recombinant human bone morphogenetic protein for instrumented atlantoaxial fusions. World Neurosurg. 2014;82(6):1369–73.CrossRefGoogle Scholar
  41. 41.
    Hamilton DK, Smith JS, Reames DL, Williams BJ, Shaffrey CI. Use of recombinant human bone morphogenetic protein-2 as an adjunct for instrumented posterior arthrodesis in the occipital cervical region: an analysis of safety, efficacy, and dosing. J Craniovertebr Junction Spine. 2010;1(2):107–12.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Avery L. Buchholz
    • 1
  • John C. Quinn
    • 2
  • Christopher I. Shaffrey
    • 3
    Email author
  • Justin S. Smith
    • 3
  1. 1.Department of Neurological SurgeryMedical University of South CarolinaCharlestonUSA
  2. 2.Department of NeurosurgeryUniversity of Virginia Health SystemCharlottesvilleUSA
  3. 3.Departments of Orthopaedic and Neurological SurgeryDuke University Health SystemDurhamUSA

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