C2 medial pedicle screw: a novel “in-out-in” technique as an alternative option for posterior C2 fixation in cases with a narrow C2 isthmus

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  • Department of Neurosurgery, Chinese PLA General Hospital, Haidian District, Beijing, China
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OBJECTIVE

The authors describe a novel “in-out-in” technique as an alternative option for posterior C2 screw fixation in cases that involve narrow C2 isthmus. Here, they report the preliminary radiological and clinical outcomes in 12 patients who had a minimum 12-month follow-up period.

METHODS

Twelve patients with basilar invagination and atlantoaxial dislocation underwent atlantoaxial reduction and fixation. All patients had unilateral hypoplasia of the C2 isthmus that prohibited insertion of pedicle screws. A new method, the C2 medial pedicle screw (C2MPS) fixation, was used as an alternative. In this technique, the inner cortex of the narrow C2 isthmus was drilled to obtain space for screw insertion, such that the lateral cortex could be well preserved and the risk of vertebral artery injury could be largely reduced. The C2MPS traveled along the drilled inner cortex into the anterior vertebral body, achieving a 3-column fixation of the axis with multicortical purchase.

RESULTS

Satisfactory C2MPS placement and reduction were achieved in all 12 patients. No instance of C2MPS related vertebral artery injury or dural laceration was observed. There were no cases of implant failure, and solid fusion was demonstrated in all patients.

CONCLUSIONS

This novel in-out-in technique can provide 3-column rigid fixation of the axis with multicortical purchase. Excellent clinical outcomes with low complication rates were achieved with this technique. When placement of a C2 pedicle screw is not possible due to anatomical constraints, the C2MPS can be considered as an efficient alternative.

ABBREVIATIONS AAD = atlantoaxial dislocation; BI = basilar invagination; C2MPS = C2 medial pedicle screw; VA = vertebral artery.

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Contributor Notes

Correspondence Guang-Yu Qiao: Chinese PLA General Hospital, Haidian District, Beijing, China. qgy301@126.com.

INCLUDE WHEN CITING Published online May 1, 2020; DOI: 10.3171/2020.2.SPINE191517.

Y.Q.D. and Y.H.Y. contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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