Limitations of TA + Hook Technique

  • Songkai Li
  • Fengjin Zhou
Part of the Translational Medicine Research book series (TRAMERE)


Although the previous section showed that the TA + Hook technique is an excellent technique that provided more rigid stabilization and higher fusion rates for the treatment of atlantoaxial instability, this technique still has some limitations, including potential injury to the vertebral arteries, complete preoperation reduction of the atlantoaxial joint, and unsuitability for patients with fracture or congenital absence of the posterior arch of atlas. Based on the anatomical study of the atlantoaxial lateral masses, a lateral mass fusion cage was designed. The biomechanical study demonstrated that the C1 + C2 + Cage technique, when the posterior lamina of the atlas is absent or removed for decompression, might be a viable option for the stabilization of the atlantoaxial complex.


  1. 1.
    Ni B, Chen HJ, Guo X, Tao CS. Bilateral C1-C2 transarticular screw and C1 laminar hook fixation. Chin J Surg. 2005;43:1358–9.Google Scholar
  2. 2.
    Guo X, Ni B, Zhao WD, Wang MF, Zhou FJ, Li SK, Ren ZW. Biomechanical assessment of bilateral C1 laminar hook and C1-2 transarticular screws and bone graft for atlantoaxial instability. J Spinal Disord Tech. 2009;22:578–85.CrossRefGoogle Scholar
  3. 3.
    Guo QF, Liu J, Ni B, Lu XH, Zhou FJ. C2 laminar screw and C1-2 transarticular screw combined with C1 laminar hooks for atlantoaxial instability with unilateral vertebral artery injury. Arch Orthop Trauma Surg. 2011;131:1207–10.CrossRefPubMedGoogle Scholar
  4. 4.
    Guo X, Ni B, Wang MF, Wang J, Li SK, Zhou FJ. Bilateral atlas laminar hook combined with transarticular screw fixation for an unstable bursting atlantal fracture. Arch Orthop Trauma Surg. 2009;129:1203–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Guo X, Ni B, Xie N, Lu XH, Guo QF, Lu M. Bilateral C1-C2 transarticular screw and C1 laminar hook fixation and bone graft fusion for reducible atlantoaxial dislocation: a seven-year analysis of outcome. PLoS One. 2014;9:e87676.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Ni B, Guo X, Xie N, Li SK, Zhou FJ, Zhang F, Liu Q. C1-2 transarticular screws combined with C1 laminar hooks fixation: a modified posterior atlantoaxial fixation technique and outcome in 72 patients. Eur Spine J. 2013;22:260–7.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Ni B, Guo X, Xie N, Lu XH, Yuan W, Li SK, Zhou FJ, Zhu ZC. Bilateral atlantoaxial transarticular screws and atlas laminar hooks fixation for pediatric atlantoaxial instability. Spine (Phila Pa 1976). 2010;35:E1367–72.CrossRefPubMedGoogle Scholar
  8. 8.
    Farey ID, Nadkarni S, Smith N. Modified Gallie technique versus transarticular screw fixation in C1-C2 fusion. Clin Orthop Relat Res. 1999;359:126–35.CrossRefGoogle Scholar
  9. 9.
    Madawi AA, Solanki GA, Casey AT, Crockard HA. Variation of the groove in the axis vertebra for the vertebral artery. Implications for instrumentation. J Bone Joint Surg Br. 1997;79:820–3.CrossRefGoogle Scholar
  10. 10.
    Goel A, Gupta S. Vertebral artery injury with transarticular screws. J Neurosurg. 1999;90:376–7.Google Scholar
  11. 11.
    Madawi AA, Casey AT, Solanki GA, Tuite G, Veres R, Crockard HA. Radiological and anatomical evaluation of the atlantoaxial transarticular screw fixation technique. J Neurosurg. 1997;86:961–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Gluf WM, Schmidt MH, Apfelbaum RI. Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications, and lessons learned in 191 adult patients. J Neurosurg Spine. 2005;2:155–63.CrossRefPubMedGoogle Scholar
  13. 13.
    Wright NM, Lauryssen C. Vertebral artery injury in C1-2 transarticular screw fixation: results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves. American Association of Neurological Surgeons/Congress of Neurological Surgeons. J Neurosurg. 1998;88:634–40.CrossRefPubMedGoogle Scholar
  14. 14.
    Grob D, Bremerich FH, Dvorak J, Mannion AF. Transarticular screw fixation for osteoarthritis of the atlanto axial segment. Eur Spine J. 2006;15:283–91.CrossRefPubMedGoogle Scholar
  15. 15.
    Stillerman CB, Wilson JA. Atlanto-axial stabilization with posterior transarticular screw fixation: technical description and report of 22 cases. Neurosurgery. 1993;32:948-54; discussion 954–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Dickman CA, Sonntag VK. Posterior C1-C2 transarticular screw fixation for atlantoaxial arthrodesis. Neurosurgery. 1998;43:275–80;discussion 280–1.CrossRefPubMedGoogle Scholar
  17. 17.
    Papagelopoulos PJ, Currier BL, Hokari Y, Neale PG, Zhao C, Berglund LJ, Larson DR, An KN. Biomechanical comparison of C1-C2 posterior arthrodesis techniques. Spine (Phila Pa 1976). 2007;32:E363–70.CrossRefPubMedGoogle Scholar
  18. 18.
    Bloch O, Holly LT, Park J, Obasi C, Kim K, Johnson JP. Effect of frameless stereotaxy on the accuracy of C1–2 transarticular screw placement. J Neurosurg. 2001;95:74–9.Google Scholar
  19. 19.
    Jeanneret B, Magerl F. Primary posterior fusion C1/2 in odontoid fractures: indications, technique, and results of transarticular screw fixation. J Spinal Disord. 1992;5:464–75.CrossRefPubMedGoogle Scholar
  20. 20.
    Dickman CA, Sonntag VK. Surgical management of atlantoaxial nonunions. J Neurosurg. 1995;83:248–53.CrossRefPubMedGoogle Scholar
  21. 21.
    Nakagawa T, Yone K, Sakou T, Yanase M. Occipitocervical fusion with C1 laminectomy in children. Spine (Phila Pa 1976). 1997;22:1209–14.CrossRefGoogle Scholar
  22. 22.
    Li SK, Ni B, Xie N, Wang MF, Guo X, Zhang F, Wang J, Zhao WD. Biomechanical evaluation of an atlantoaxial lateral mass fusion cage with C1–C2 pedicle fixation. Spine (Phila Pa 1976). 2010;35:E624–32.CrossRefPubMedGoogle Scholar
  23. 23.
    Wang MF. Design and biomechanical study of the novel posterior atlantoaxial fixator composed of bilateral transarticular screws and Cl laminar hooks. Shanghai: Second Military Medical University; 2008.Google Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. and Shanghai Jiao Tong University Press 2018

Authors and Affiliations

  • Songkai Li
    • 1
  • Fengjin Zhou
    • 2
  1. 1.Department of OrthopedicsLanzhou General HospitalLanzhouChina
  2. 2.Department of Spinal SurgeryXi’an Zhongde Orthopedics HospitalXi’anChina

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