Skip to main content

Advertisement

SpringerLink
Log in

Bicortical facet screws as a new option for posterior C2 fixation: anatomical study and clinical experience

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

C2 fixation is a demanding procedure, particularly in patients with variants of C1–C2 anatomy. The inferior articular process (IAP) of the axis can be an alternative for screw placement. We report the results of a CT study of C2 IAP anatomy and we present the clinical experience of 28 patients operated with this technique.

Methods

Anatomical study: 50 CT angiographies of the vertebral arteries (VA) were used for this study and, therefore, 100 IAPs were considered. We measured on the axial and sagittal planes the length, height and width of the facet, the distance between the anterior cortex and the VA and the distance between the screw entry point and the VA. We also measured the angle between the sagittal plane and the external tangent line of the VA. Clinical report: 28 patients were treated with C2 IAP screws at the Spine Surgery Department of the University Hospital in Lyon, France, from January 2014 to January 2016.

Results

Anatomical study: the mean length of C2 IAP was 12 ± 2 mm, the mean distance between the anterior cortical layer and the VA was 5.2 ± 1.4 mm, and the mean angle we found was 0.2° ± 5.3°. Clinical report: 16 of the 28 patients presented post-traumatic C1–C2 instability, 8 patients presented degenerative disease, 1 patient was treated for pseudoarthrosis, 1 for tumour, 1 for OPLL and 1 for rheumatoid arthritis. All the screws were correctly positioned and there was no VA injury.

Conclusion

IAP screws can represent a safe alternative option for C2 fixation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Huang DG, Hao DJ, He BR et al (2015) Posterior atlantoaxial fixation: a review of all techniques. Spine J 15:2271–2281

    Article  PubMed  Google Scholar 

  2. Menendez JA, Wright NM (2007) Techniques of posterior C1–C2 stabilization. Neurosurgery 60(Suppl 1):S103–S111

    PubMed  Google Scholar 

  3. Mummaneni PV, Haid RW (2005) Atlantoaxial fixation: overview of all techniques. Neurol India 53:408–415

    Article  PubMed  Google Scholar 

  4. Holness RO, Huestis WS, Howes WJ, Langille RA (1984) Posterior stabilization with an interlaminar clamp in cervical injuries: technical note and review of the long term experience with the method. Neurosurgery 14:318–322

    Article  CAS  PubMed  Google Scholar 

  5. Hanimoglu H, Hanci L, Kaynar MY, Hanci M (2009) Bilateral C1–C2 claw for atlantoaxial instability. Turk Neurosurg 19:345–348

    PubMed  Google Scholar 

  6. Gallie W (1939) Fractures and dislocations of the cervical spine. Am J Surg 46:495–499

    Article  Google Scholar 

  7. Brooks AL, Jenkins EB (1978) Atlanto-axial arthrodesis by the wedge compression method. J Bone Jt Surg Am 60:279–284

    Article  CAS  Google Scholar 

  8. Dickman CA, Sonntag VK, Papadopoulos SM, Hadley MN (1991) The interspinous method of posterior atlantoaxial arthrodesis. J Neurosurg 74:190–198

    Article  CAS  PubMed  Google Scholar 

  9. Harms J, Melcher RP (2001) Posterior C1–C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976) 26:2467–2471

    Article  CAS  Google Scholar 

  10. Goel A, Laheri V (1994) Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir (Wien) 129(1–2):47–53

    Article  CAS  Google Scholar 

  11. Yanni DS, Perin NI (2010) Fixation of the axis. Neurosurgery 66:A147–A152

    Article  PubMed  Google Scholar 

  12. Wright NM (2004) Posterior C2 fixation using bilateral, crossing C2 laminar screws: case series and technical note. J Spinal Disord Tech 17(2):158–162

    Article  PubMed  Google Scholar 

  13. Lucas F, Mitton D, Frechede B, Barrey C (2016) Short isthmic versus long trans-isthmic C2 screw: anatomical and biomechanical evaluation. Eur J Orthop Surg Traumatol. [Epub ahead of print] PubMed PMID: 27170334

  14. Magerl F, Seemann PS (1986) Stable posterior fusion of the atlas and axis by transarticular screw fixation. In: Kehr P, Wiedner A, Cervical Spine Research Society (eds) Cervical Spine I. Springer, New York, pp 322–327

    Google Scholar 

  15. Farey ID, Nadkarni S, Smith N (1999) Modified Gallie technique versus transarticular screw fixation in C1–C2 fusion. Clin Orthop Relat Res 359:126–135

    Article  Google Scholar 

  16. Peng CW, Chou BT, Bendo JA, Spivak JM (2009) Vertebral artery injury in cervical spine surgery: anatomical considerations, management, and preventive measures. Spine J 9:70–76

    Article  PubMed  Google Scholar 

  17. Lunardini DJ, Eskander MS, Even JL et al (2014) Vertebral artery injuries in cervical spine surgery. Spine J 14:1520–1525

    Article  PubMed  Google Scholar 

  18. Yoshida M, Neo M, Fujibayashi S, Nakamura T (2006) Comparison of the anatomical risk for vertebral artery injury associated with the C2-pedicle screw and atlantoaxial transarticular screw. Spine (Phila Pa 1976) 31:E513–E517

    Article  Google Scholar 

  19. Tokuda K, Miyasaka K, Abe H, Abe S, Takei H, Sugimoto S, Tsuru M (1985) Anomalous atlantoaxial portions of vertebral and posterior inferior cerebellar arteries. Neuroradiology 27:410–413

    Article  CAS  PubMed  Google Scholar 

  20. Coyne TJ, Fehlings MG, Wallace MC, Bernstein M, Tator CH (1995) C1–C2 posterior cervical fusion: long-term evaluation of results and efficacy. Neurosurgery 37:688–693

    Article  CAS  PubMed  Google Scholar 

  21. Elliott RE, Tanweer O, Boah A, Morsi A, Ma T, Smith ML et al (2012) Atlantoaxial fusion with screw–rod constructs: meta-analysis and review of literature. World Neurosurg. doi:10.1016/j.wneu.2012.03.013

    Google Scholar 

  22. Roy-Camille R, Saillant G, Laville C et al (1992) Treatment of lower cervical spinal injuries—C3 to C7. Spine (Phila Pa 1976) 17:S442–S446

    Article  CAS  Google Scholar 

  23. Jeanneret B, Magerl F, Ward EH et al (1991) Posterior stabilization of the cervical spine with hook plates. Spine (Phila Pa 1976) 16:S56–S63

    Article  CAS  Google Scholar 

  24. An HS, Gordin R, Renner K (1991) Anatomic considerations for plate-screw fixation of the cervical spine. Spine (Phila Pa 1976) 16(10 suppl):S548–S551

    Article  CAS  Google Scholar 

  25. Anderson PA, Henley MB, Grady MS et al (1991) Posterior cervical arthrodesis with AO reconstruction plates and bone graft. Spine (Phila Pa 1976) 16:S72–S79

    Article  CAS  Google Scholar 

  26. Wang S, Wang C, Leng H, Zhao W, Yan M, Zhou H (2016) Pedicle screw combined with lateral mass screw fixation in the treatment of basilar invagination and congenital C2–C3 fusion. Clin Spine Surg. 29(10):448–453

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Spine Surgery Department, Lyon University Hospital, 52 Boulevard Pinel, 69500, Bron, France

    Angelo Rusconi, E. Freitas-Olim, P. Coloma, R. Messerer & C. Barrey

Authors
  1. Angelo Rusconi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Freitas-Olim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Coloma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Messerer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Barrey
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Angelo Rusconi.

Ethics declarations

Conflict of interest

The authors report no conflict of interest concerning the scientific material and clinical data mentioned in this paper.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rusconi, A., Freitas-Olim, E., Coloma, P. et al. Bicortical facet screws as a new option for posterior C2 fixation: anatomical study and clinical experience. Eur Spine J 26, 1082–1089 (2017). https://doi.org/10.1007/s00586-017-4997-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-017-4997-7

Keywords

Search

Navigation