Skip to main content
SpringerLink
Log in

Craniovertebral Implants

  • Reference work entry
  • First Online:
Handbook of Orthopaedic Trauma Implantology

  • 23 Accesses

Abstract

The cranio-vertebral junction (CVJ) contains vital neurovascular structures, and traumatic injuries of the cranio-vertebral junction can affect these structures causing major disability including mortality. Various ligaments around CVJ play a vital role in protecting these neurovascular structures as bony anatomy around CVJ does not give good stability, hence CVJ trauma may compromise these ligaments which leads to instability. Knowledge about the biomechanics of CVJ is very crucial because CVJ has unique biomechanics. Various implants are available for osteosynthesis, occipito-cervical fusions, and atlantoaxial fixations in case of CVJ trauma. Implants around CVJ have started with wiring, hooks, loops and later occipito-cervical plates, occipito-cervical screw rod system, trans-articular screws, C1/2 Goel-Harms fixation, and C1/2 spacers have emerged. Osteosynthesis with anterior odontoid fixation has eliminated consequences of C1/C2 fusion. Salvage procedures like laminar screws and graft-clamp techniques are of great use when other fixations fail. Recent advancement in CVJ implants has changed the outcome of patients with CVJ trauma with excellent reduction and fixation capabilities. Complications like vertebral artery injury, excessive bleeding, dural injuries, neurological deficits, infection, and non-union should be kept in mind while treating CVJ trauma.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 1,599.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 1,599.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bisson EF, Guan J, Schmidt MH, Apfelbaum RI. Upper cervical screw fixation techniques. In: Steinmetz MP, Benzel EC, editors. Benzel’s Spine Surgery: Techniques, Complication Avoidance, and Management. 4th ed. Philadelphia: Elsevier; 2017. p. 478–90.

    Google Scholar 

  2. Baron HS, Campo EMD, Neal MT, Theodore N. Upper cervical and occipitocervical arthrodesis. In: Steinmetz MP, Benzel EC, editors. Benzel’s Spine Surgery: Techniques, Complication Avoidance, and Management. 4th ed. Philadelphia: Elsevier; 2017. p. 458–71.

    Google Scholar 

  3. Patil SS, Karunakaran S, Nene A, Basu S. Congenital cranio-vertebral anomalies. In: Kulkarni GS, Babhulkar S, editors. Textbook of Orthopedics and Trauma. 3rd ed. New Delhi: Jaypee; 2016. p. 2209–23.

    Google Scholar 

  4. Cacciola F, Phalke U, Goel A. Vertebral artery in relationship to C1–C2 vertebrae: an anatomical study. Neurol India. 2004;52(2):178–84.

    Google Scholar 

  5. Baron EM, Tunstall R. Back. In: Standring S, editor. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 41st ed. London: Elsevier; 2016. p. 710–50.

    Google Scholar 

  6. Lopez AJ, Scheer JK, Leibl KE, Smith ZA, Dlouhy BJ, Dahdaleh NS. Anatomy and biomechanics of the craniovertebral junction. Neurosurg Focus. 2015;38(4):1–8.

    Article  Google Scholar 

  7. Klineberg EO, Wang JC, Butler J, Ferrara LA, Benzel EC. Basic biomechanically relevant anatomy. In: Steinmetz MP, Benzel EC, editors. Benzel’s Spine Surgery: Techniques, Complication Avoidance, and Management. 4th ed. Philadelphia: Elsevier; 2017. p. 335–48.

    Google Scholar 

  8. White AA, Panjabi MM, editors. Clinical Biomechanics of Spine. 2nd ed. Baltimore: Lippincott, Williams & Wilkins; 1990.

    Google Scholar 

  9. Crawford NR, Peles JD, Dickman CA. The spinal lax zone and neutral zone: measurement techniques and parameter comparisions. J Spinal Disord. 1998;11(5):416–29.

    Article  CAS  PubMed  Google Scholar 

  10. Debernardi A, Talamonti G, Villa F, Piparo M, Collice M. The craniovertebral junction area and the role of the ligaments and membranes. Neurosurgery. 2011;68(2):291–301.

    Article  PubMed  Google Scholar 

  11. Panjabi M, Dvorak J, Duranceau J, et al. Three dimensional movements of upper cervical spine. Spine (Phila Pa 1976). 1988;13(7):726–30.

    Article  CAS  PubMed  Google Scholar 

  12. Panjabi MM. Stabilizing system of spine. Part 2. Neutral zone and instability hypothesisis. J Spinal Disord. 1992;5(4):390–7.

    Article  CAS  PubMed  Google Scholar 

  13. Wertheim SB, Bohlman HH. Occipitocervical fusion: indications, technique, and long-term results in thirteen patients. J Bone Jt Surg Am. 1987;69(6):833–6.

    Article  CAS  Google Scholar 

  14. Williams KD. Frcatures, dislocations and fracture-dislocations of spine. In: Canale ST, Beaty JH, editors. Cambells Operative Orthopaedics. Philadelphia: Elsevier Mosby; 2013. p. 1559–627.

    Chapter  Google Scholar 

  15. Truumees E. Cervical instrumentation: anterior and posterior. In: Herkowitz HN, Garfin SR, Eismont FJ, Bell GR, Balderston RA, editors. Rothman and Simeone; the Spine. 6th ed. Philadelphia: Elsevier Saunders; 2011. p. 1175–218.

    Chapter  Google Scholar 

  16. Motosuneya T, Hirabayashi S, Yamada H, Sakai H. Occipitocervical fusion using a hook and rod system between cervical levels C2 and C3. J Clin Neurosci. 2009;16(7):909–13.

    Article  PubMed  Google Scholar 

  17. Faure A, Monteiro R, Hamel O, Raoul S, Szapiro J, Alcheikh M, Bord E, Robert R. Inverted-hook occipital clamp system in occipitocervical fixation. J Neurosurg. 2002;97(1):135–41.

    PubMed  Google Scholar 

  18. 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.

    Article  CAS  PubMed  Google Scholar 

  19. Ahmed R, Traynelis VC, Vaccaro AR. Occipitocervical and atlantoaxial methods of fusion: C1-Fixation, harms screw, magerl screw, wiring. In: Bridwell KH, Dewald RL, editors. The Textbook of Spinal Surgery. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2011. p. 225–35.

    Google Scholar 

  20. Perin NI, Baldwin NG, Cooper PR. High cervical and occipitocervical plate, rod, wire and bone techniques. In: Steinmetz MP, Benzel EC, editors. Benzel’s Spine Surgery: Techniques, Complication Avoidance, and Management. 4th ed. Philadelphia: Elsevier; 2017. p. 472–7.

    Google Scholar 

  21. Dickman CA, Sonntag VK, Papadopoulos SM, Hadley MN. The interspinous method of posterior atlantoaxial arthrodesis. J Neurosurg. 1991;74(2):190–8.

    Article  CAS  PubMed  Google Scholar 

  22. Magerl F, Seeman PS. Stable posterior fusion of the atlas and axis by transarticular screw. In: Weidner PA, editor. Cervical Spine. New York: Spinger; 1987.

    Google Scholar 

  23. Harms J, Melcher RP. Posterior C1–C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976). 2001;26(22):2467–71.

    Article  CAS  PubMed  Google Scholar 

  24. Goel A, Desai KI, Muzumdar DP. Atlantoaxial fixation using plate and screw method: a report of 160 treated patients. Neurosurgery. 2002;51(6):1351–7.

    Article  PubMed  Google Scholar 

  25. Goel A. Treatment of basilar invagination by atlantoaxial joint distraction and direct lateral mass fixation. J Neurosurg Spine. 2004;1(3):281–6.

    Article  PubMed  Google Scholar 

  26. Goel A, Shah A. Atlantoaxial joint distraction as a treatment for basilar invagination: a report of an experience with 11 cases. Neurol India. 2008;56(2):144–50.

    Article  PubMed  Google Scholar 

  27. Chandra PS, Kumar A, Chauhan A, Ansari A, Mishra NK, Sharma BS. Distraction, compression, and extension reduction of basilar invagination and atlantoaxial dislocation: a novel pilot technique. Neurosurgery. 2013;72(6):1040–53.

    Article  PubMed  Google Scholar 

  28. 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.

    Article  PubMed  Google Scholar 

  29. Tay BKB, Eismont FJ. Injuries of the upper cervical spine. In: Herkowitz HN, Garfin SR, Eismont FJ, Bell GR, Balderston RA, editors. Rothman and Simeone; the Spine. 6th ed. Philadelphia: Elsevier Saunders; 2011. p. 1307–32.

    Chapter  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Kothari Medical Centre, Kolkata, West Bengal, India

    Saumyajit Basu

  2. Specialist Hospital, Bengaluru, Karnataka, India

    Somashekar Doddabhadre Gowda

Authors
  1. Saumyajit Basu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Somashekar Doddabhadre Gowda
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. NH Narayana Superspeciality and Multispeciality Hospitals, Howrah, West Bengal, India

    Arindam Banerjee

  2. Technical University of Munich, Munich, Germany

    Peter Biberthaler

  3. Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry, India

    Saseendar Shanmugasundaram

Section Editor information

  1. AMRI Hospital, Kolkata, West Bengal, India

    Chinmay Nath

Rights and permissions

Reprints and permissions

Copyright information

© 2023 Springer Nature Singapore Pte Ltd.

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Basu, S., Doddabhadre Gowda, S. (2023). Craniovertebral Implants. In: Banerjee, A., Biberthaler, P., Shanmugasundaram, S. (eds) Handbook of Orthopaedic Trauma Implantology. Springer, Singapore. https://doi.org/10.1007/978-981-19-7540-0_104

Download citation

  • DOI: https://doi.org/10.1007/978-981-19-7540-0_104

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-19-7539-4

  • Online ISBN: 978-981-19-7540-0

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation