Minimally Invasive Approach to Posterior Occiput to C2

Abstract

The C1–C2 joint is affected by multiple entities that may produce biomechanical instability. Optimal management for atlanto-axial instability has been searched by ways of different surgical techniques with different results, generating discussion between second effects of a particular treatment. Posterior cervical approach dissections can place the axial neck musculature and ligaments at risk of neural denervations or vascular compromise. Either of these entities may result in significant postoperative atrophy, cervical pain, and spine instability. Minimally invasive techniques for the treatment of spinal disorders allow to our patients less morbid procedures with equal or better results compared to conventional surgery. In the following chapter, we review the anatomy of the atlanto-axial joint and propose a minimally invasive trans-muscular C1–C2 fusion technique using C1 lateral-mass screws and C2 pedicular screws. We describe cases with surgical, clinical, and radiographic follow-up.

Keywords

Atlanto-axial joint C1–C2 instability Minimally invasive Spinal fusion Dens fracture 

References

  1. 1.
    Claybrooks R, Kayanja M, Milks R, Benzel E. Atlantoaxial fusion: a biomechanical analysis of two C1-C2 fusion techniques. Spine J. 2007;7:682–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Diaz R, Berbeo M, Vergara M, Villalobos L. Minimally invasive posterior C1-C2 screw fixation through an anatomical corridor preserving occipital-cervical tension band. Prospective 21 months clinical and radiological study. Oral presentation, Spine Arthroplasty Society global symposium on motion preservation technology (SAS 9), London, England, May 2009.Google Scholar
  3. 3.
    Farey I, Nadkarni S, Smith N. Modified Gallie technique versus transarticular screw fixation in C1-C2 fusion. Clin Orthop Relat Res. 1999;359:126–35.CrossRefPubMedGoogle Scholar
  4. 4.
    Fessler R, O’Toole J, Eichholz K, Perez-Cruet M. The development of minimally invasive spine surgery. Neurosurg Clin N Am. 2006;17:401–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Gala VC, O’Toole JE, Voyadzis JM, Fessler RG. Posterior minimally invasive approaches for the cervical spine. Orthop Clin N Am. 2007;38(3):339–49, abstract v.CrossRefGoogle Scholar
  6. 6.
    Gerszten PC, Welch WC. Spine: minimally invasive techniques. Prog Neurol Surg. 2006;19:135–51.CrossRefPubMedGoogle Scholar
  7. 7.
    Goel A, Laheri V. Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir (Wien). 1994;129:47–53.CrossRefGoogle Scholar
  8. 8.
    Goel A, Desai KI, Muzumdar DP. Atlanto axial fixation using plate and screw method: a report of 160 cases treated patients. Neurosurgery. 2002;51:1351–7.PubMedGoogle Scholar
  9. 9.
    Harms J, Melcher R. Posterior C1-C2 fusion with poliaxial screw and rod fixation. Spine. 2001;26(22):2467–71.CrossRefPubMedGoogle Scholar
  10. 10.
    Joseffer S, Post N, Cooper P, Fremong-Boadu A. Minimally invasive atlantoaxial fixation with polyaxial screw-rod construct: technical case report. Neurosurgery. 2006;58 Suppl 2:ONS-375.Google Scholar
  11. 11.
    Menendez J, Wright N. Techniques of posterior C1-C2 stabilization. Neurosurgery. 2007;60 Suppl 1:103–11.Google Scholar
  12. 12.
    Neo M, Sakamoto T, Fujibayashi S, Nakamura T. A safe screw trajectory for atlantoaxial transarticular fixation achieved using an aiming device. Spine. 2005;30(9):236–42.CrossRefGoogle Scholar
  13. 13.
    O’Toole JE, Eichholz KM, Fessler RG. Minimally invasive approaches to vertebral column and spinal cord tumors. Neurosurg Clin N Am. 2006;17(4):491–506.CrossRefPubMedGoogle Scholar
  14. 14.
    Powers C, Isaacs R. Minimally invasive fusion and fixation techniques. Neurosurg Clin N Am. 2006;17:477–89.CrossRefPubMedGoogle Scholar
  15. 15.
    Reilly T, Sasso R, Hall P. Atlantoaxial stabilization: clinical comparison of posterior cervical wiring technique with transarticular screw fixation. J Spinal Disord Tech. 2003;16(3):248–53.CrossRefPubMedGoogle Scholar
  16. 16.
    Shad A, Shariff S, Teddy P. Craniocervical fusion for rheumatoid arthritis: comparison of sublaminar wires and the lateral mass screw craniocervical fusion. Br J Neurosurg. 2002;16(5):483–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Shchedrenok VV, Ivanenko AV, Sebelev KI, Moguchaia OV. Minimally invasive surgery of degenerative diseases of the spine. Vestnik Khirurgii Imeni II Grekova. 2010;169(2):102–4.PubMedGoogle Scholar
  18. 18.
    Wang M, Levi A. Minimally invasive lateral mass screw fixation in the cervical spine: initial clinical experience with long-term follow-up. Neurosurgery. 2006;58:907–12.CrossRefPubMedGoogle Scholar
  19. 19.
    Winder MJ, Thomas KC. Minimally invasive versus open approach for cervical laminoforaminotomy. Can J Neurol Sci. 2011;38(2):262–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Xiang-Yang M, Qing-Shui Y, Zeng-Hui W, Hong X, Jing-Fa L, Shi-Zhen Z. Anatomic considerations for the pedicle screw placement in the first cervical vertebra. Spine. 2005;30(13):1519–23.CrossRefGoogle Scholar
  21. 21.
    Yoshida M, Neo M, Fujibayashi S, Nakamura T. Comparison of the anatomical risk for vertebral artery injury associated with the C2-pedicle screw and atlantoaxial transarticular screw. Spine. 2006;31(15):513–7.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Edificio Global Medical CenterBogotáColombia
  2. 2.Unidad de Neurocirugía, Hospital Universitario San Ignacio, Pontificia Universidad JaverianaBogotáColombia

Personalised recommendations