Translaminar rigid screw fixation of the axis

Technical note

Restricted access

✓ Rigid fixation of the axis with C1–2 transarticular screws or C-2 pedicle screws results in high fusion rates but remains technically demanding because of the risk of injury to the vertebral artery (VA) and the limitations imposed by anatomical variability. Translaminar fixation of the axis with crossing bilateral screws provides rigid fixation and is technically simple, is not affected by variations in individual anatomy, and does not place the VA at risk. The longterm results in 20 patients treated with translaminar fixation for craniocervical, atlantoaxial, and axial—subaxial instability are presented, with 100% fusion rates and no neurological or vascular complications. Translaminar screws may be a good option for rigid fixation of the axis for surgeons not proficient in the more technically demanding methods of stabilization.

Article Information

Address reprint requests to: Neill M. Wright, M.D., Department of Neurological Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Box 8057, St. Louis, Missouri 63110. email: wrightn@nsurg.wustl.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Postoperative radiographs depicting C-1 lateral mass screws and bilateral C-2 translaminar screws. Lateral (upper) and open-mouth (lower) views.

  • View in gallery

    Postoperative CT scans obtained at 6 months. Left: Axial view depicting screws within both laminae. Note that the distal aspect of the screw has penetrated the dorsal aspect of the lamina but not the spinal canal. During placement, a trajectory is chosen so that any breakout occurs dorsally, not ventrally. Right: Sagittal reconstruction depicting solid bridging bone between the posterior arch of C-1 and the spinous process of C-2.

  • View in gallery

    Lateral radiograph of an occiput—C2 construct with occipital screws, bilateral C-1 lateral mass screws, and bilateral crossing C-2 translaminar screws.

  • View in gallery

    Illustration showing the C1–2 translaminar technique. Lateral (left) and anteroposterior (right) views.

References

  • 1.

    Borm WKonig RWAlbrecht ARichter HPKast E: Percutaneous transarticular atlantoaxial screw fixation using a cannulated screw system and image guidance. Minim Invasive Neurosurg 47:1111142004Borm W Konig RW Albrecht A Richter HP Kast E: Percutaneous transarticular atlantoaxial screw fixation using a cannulated screw system and image guidance. Minim Invasive Neurosurg 47:111–114 2004

    • Search Google Scholar
    • Export Citation
  • 2.

    Brooks ALJenkins EB: Atlanto-axial arthrodesis by the wedge compression method. J Bone Joint Surg Am 60:2792841978Brooks AL Jenkins EB: Atlanto-axial arthrodesis by the wedge compression method. J Bone Joint Surg Am 60:279–284 1978

    • Search Google Scholar
    • Export Citation
  • 3.

    Dickman CASonntag VK: Posterior C1–C2 transarticular screw fixation for atlantoaxial arthrodesis. Neurosurgery 43:2752811998Dickman CA Sonntag VK: Posterior C1–C2 transarticular screw fixation for atlantoaxial arthrodesis. Neurosurgery 43:275–281 1998

    • Search Google Scholar
    • Export Citation
  • 4.

    Dickman CASonntag VKPapadopoulos SMHadley MN: The interspinous method of posterior atlantoaxial arthrodesis. J Neurosurg 74:1901981991Dickman CA Sonntag VK Papadopoulos SM Hadley MN: The interspinous method of posterior atlantoaxial arthrodesis. J Neurosurg 74:190–198 1991

    • Search Google Scholar
    • Export Citation
  • 5.

    Ebraheim NRollins JRXu RJackson WT: Anatomic consideration of C-2 PS placement. Spine 21:6916951996Ebraheim N Rollins JR Xu R Jackson WT: Anatomic consideration of C-2 PS placement. Spine 21:691–695 1996

    • Search Google Scholar
    • Export Citation
  • 6.

    Fountas KNSmisson HF IIIRobinson JS Jr: C1–C2 transarticular screw fixation for atlantoaxial instability: a 6-year experience. Neurosurgery 50:6726732002Fountas KN Smisson HF III Robinson JS Jr: C1–C2 transarticular screw fixation for atlantoaxial instability: a 6-year experience. Neurosurgery 50:672–673 2002

    • Search Google Scholar
    • Export Citation
  • 7.

    Gluf WMSchmidt MHApfelbaum RI: Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications, and lessons learned in 191 adult patients. J Neurosurg Spine 2:1551632005Gluf 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 2:155–163 2005

    • Search Google Scholar
    • Export Citation
  • 8.

    Goel A: C1–C2 PS fixation with rigid cantilever beam construct: case report and technical note. Neurosurgery 51:8538542002Goel A: C1–C2 PS fixation with rigid cantilever beam construct: case report and technical note. Neurosurgery 51:853–854 2002

    • Search Google Scholar
    • Export Citation
  • 9.

    Goel ADesai KIMuzumdar DP: Atlantoaxial fixation using plate and screw method: a report of 160 treated patients. Neurosurgery 51:135113572002Goel A Desai KI Muzumdar DP: Atlantoaxial fixation using plate and screw method: a report of 160 treated patients. Neurosurgery 51:1351–1357 2002

    • Search Google Scholar
    • Export Citation
  • 10.

    Goel ALaheri V: Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir 129:47531994Goel A Laheri V: Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir 129:47–53 1994

    • Search Google Scholar
    • Export Citation
  • 11.

    Haid RW JrSubach BRMcLaughlin MRRodts GE JrWahlig JB Jr: C1–C2 transarticular screw fixation for atlantoaxial instability: a 6-year experience. Neurosurgery 49:65702001Haid RW Jr Subach BR McLaughlin MR Rodts GE Jr Wahlig JB Jr: C1–C2 transarticular screw fixation for atlantoaxial instability: a 6-year experience. Neurosurgery 49:65–70 2001

    • Search Google Scholar
    • Export Citation
  • 12.

    Harms JMelcher RP: Posterior C1–C2 fusion with polyaxial screw and rod fixation. Spine 26:246724712001Harms J Melcher RP: Posterior C1–C2 fusion with polyaxial screw and rod fixation. Spine 26:2467–2471 2001

    • Search Google Scholar
    • Export Citation
  • 13.

    Jeanneret BMagerl F: Primary posterior fusion C1/2 in odontoid fractures: indications, technique, and results of transarticular screw fixation. J Spinal Disord 5:4644751992Jeanneret B Magerl F: Primary posterior fusion C1/2 in odontoid fractures: indications technique and results of transarticular screw fixation. J Spinal Disord 5:464–475 1992

    • Search Google Scholar
    • Export Citation
  • 14.

    Kim SMLim TJPaterno JHwang TJLee KWBalabhadra RSet al: Biomechanical comparison of anterior and posterior stabilization methods in atlantoaxial instability. J Neurosurg 100 (3 Suppl):2772832004Kim SM Lim TJ Paterno J Hwang TJ Lee KW Balabhadra RS et al: Biomechanical comparison of anterior and posterior stabilization methods in atlantoaxial instability. J Neurosurg 100 (3 Suppl):277–283 2004

    • Search Google Scholar
    • Export Citation
  • 15.

    Kuroki HRengachary SSGoel VKHolekamp SAPitkanen VEbraheim NA: Biomechanical comparison of two stabilization techniques of the atlantoaxial joints: transarticular screw fixation versus screw and rod fixation. Neurosurgery 56:1511592005Kuroki H Rengachary SS Goel VK Holekamp SA Pitkanen V Ebraheim NA: Biomechanical comparison of two stabilization techniques of the atlantoaxial joints: transarticular screw fixation versus screw and rod fixation. Neurosurgery 56:151–159 2005

    • Search Google Scholar
    • Export Citation
  • 16.

    Low HLRedfern RM: C1–C2 transarticular screw fixation for atlantoaxial instability: a 6-year experience, and C1–C2 transarticular screw fixation—technical aspects. Neurosurgery 50:116511662002Low HL Redfern RM: C1–C2 transarticular screw fixation for atlantoaxial instability: a 6-year experience and C1–C2 transarticular screw fixation—technical aspects. Neurosurgery 50:1165–1166 2002

    • Search Google Scholar
    • Export Citation
  • 17.

    Madawi AACasey ATSolanki GATuite GVeres RCrockard HA: Radiological and anatomical evaluation of the atlantoaxial transarticular screw fixation technique. J Neurosurg 86:9619681997Madawi AA Casey AT Solanki GA Tuite G Veres R Crockard HA: Radiological and anatomical evaluation of the atlantoaxial transarticular screw fixation technique. J Neurosurg 86:961–968 1997

    • Search Google Scholar
    • Export Citation
  • 18.

    Melcher RPPuttlitz CMKleinstueck FSLotz JCHarms JBradford DS: Biomechanical testing of posterior atlantoaxial fixation techniques. Spine 27:243524402002Melcher RP Puttlitz CM Kleinstueck FS Lotz JC Harms J Bradford DS: Biomechanical testing of posterior atlantoaxial fixation techniques. Spine 27:2435–2440 2002

    • Search Google Scholar
    • Export Citation
  • 19.

    Nichols LAMukherjee DPOgden ALSadasivan KKAlbright JA: A biomechanical study of unilateral posterior atlantoaxial transarticular screw fixation. J Long Term Eff Med Implants 15:33382005Nichols LA Mukherjee DP Ogden AL Sadasivan KK Albright JA: A biomechanical study of unilateral posterior atlantoaxial transarticular screw fixation. J Long Term Eff Med Implants 15:33–38 2005

    • Search Google Scholar
    • Export Citation
  • 20.

    Paramore CGDickman CASonntag VK: The anatomical suitability of the C1–2 complex for transarticular screw fixation. J Neurosurg 85:2212241996Paramore CG Dickman CA Sonntag VK: The anatomical suitability of the C1–2 complex for transarticular screw fixation. J Neurosurg 85:221–224 1996

    • Search Google Scholar
    • Export Citation
  • 21.

    Resnick DKBenzel EC: C1–C2 PS fixation with rigid cantilever beam construct: case report and technical note. Neurosurgery 50:4264282002Resnick DK Benzel EC: C1–C2 PS fixation with rigid cantilever beam construct: case report and technical note. Neurosurgery 50:426–428 2002

    • Search Google Scholar
    • Export Citation
  • 22.

    Stokes JKVillavicencio ATLiu PCBray RSJohnson JP: Posterior atlantoaxial stabilization: new alternative to C1–2 transarticular screws. Neurosurg Focus 12(1):E62002Stokes JK Villavicencio AT Liu PC Bray RS Johnson JP: Posterior atlantoaxial stabilization: new alternative to C1–2 transarticular screws. Neurosurg Focus 12(1):E6 2002

    • Search Google Scholar
    • Export Citation
  • 23.

    Wright NM: Posterior C-2 fixation using bilateral, crossing C-2 laminar screws: case series and technical note. J Spinal Disord Tech 17:1581622004Wright NM: Posterior C-2 fixation using bilateral crossing C-2 laminar screws: case series and technical note. J Spinal Disord Tech 17:158–162 2004

    • Search Google Scholar
    • Export Citation
  • 24.

    Wright NMLauryssen C: Techniques of posterior C1–C2 stabilization. Techn Neurosurg 4:2862971998Wright NM Lauryssen C: Techniques of posterior C1–C2 stabilization. Techn Neurosurg 4:286–297 1998

    • Search Google Scholar
    • Export Citation
  • 25.

    Wright NMLauryssen 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. J Neurosurg 88:6346401998Wright 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. J Neurosurg 88:634–640 1998

    • Search Google Scholar
    • Export Citation

Cited By

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 134 134 16
Full Text Views 82 82 0
PDF Downloads 113 113 0
EPUB Downloads 0 0 0

PubMed

Google Scholar