Feasibility of lateral mass screw insertion in patients with the risky triad of C1: evaluation of the over-the-arch technique

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  • 1 Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, Uijeongbusi, Republic of Korea;
  • | 2 Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea;
  • | 3 College of Art and Science, Emory University, Atlanta, Georgia;
  • | 4 Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Daejeon, Republic of Korea; and
  • | 5 Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyangsi, Republic of Korea
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OBJECTIVE

The objective of this study was to evaluate the feasibility and complications of the over-the-arch (OTA) technique for screw insertion into the C1 lateral mass in patients in whom conventional techniques (i.e., posterior arch [PA] and inferior lateral mass [ILM]) are not feasible due to 1) PA with a very small height (< 3.5 mm), 2) a caudally tilted PA blocking the inferior part of the C1 lateral mass, or 3) loss of height at the ILM (< 3.5 mm).

METHODS

The authors reviewed the medical records of 60 patients who underwent C1 screw fixation with the OTA technique (13 screws) and the PA/ILM technique (107 screws) between 2011 and 2019. Vertebral artery (VA) injuries, screw malposition, and bony union were radiologically assessed. Clinical outcome measures, including Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) scale score, and occipital neuralgia, were recorded.

RESULTS

Thirteen OTA screws were successfully inserted without any major complications. NDI and JOA scale scores did not show significant differences between the two groups at final follow-up. No VA injuries were recognized during screw insertion. There was no evidence of ischemic damage to the VA or bony erosion in the occiput or atlas. Medial wall violation was observed in 1 screw (7.7%); however, no C0–1, C1–2, or lateral wall violations were observed. No patients developed new-onset neuralgia postoperatively after C1 fixation with the OTA technique.

CONCLUSIONS

The OTA technique was safe and useful for C1 screw fixation in patients in whom conventional techniques could not be employed.

ABBREVIATIONS

ILM = inferior lateral mass; JOA = Japanese Orthopaedic Association; NDI = Neck Disability Index; OCF = occipitocervical fixation; OTA = over-the arch; PA = posterior arch; SLM = superior lateral mass; VA = vertebral artery.

Illustration from Lee et al. (pp 822–829). Copyright Sun Joo Kim. Published with permission.

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