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Archives of Orthopaedic and Trauma Surgery
Published in: Archives of Orthopaedic and Trauma Surgery 1/2009

01-01-2009 | Orthopaedic Surgery

Safety of atlantoaxial fusion using laminar and transarticular screws combined with an atlas hook in a patient with unilateral vertebral artery occlusion (case report)

Authors: Yoshihisa Sugimoto, Masato Tanaka, Kazuo Nakanishi, Haruo Misawa, Tomoyuki Takigawa, Yasuo Ito, Toshifumi Ozaki

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 1/2009

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Abstract

Objective and importance

A disadvantage of transarticular and C2 pedicle screws is vertebral artery (VA) injury as a result of screw misplacement. If unilateral occlusion of the VA is present, VA injury of the dominant side will cause fatal complications as a result of collateral flow insufficiency. Several authors have recently reported the usefulness of C2 laminar screws because of their safety on VA injury. We used transarticular and C2 laminar screws combined with the atlas hook in a patient with C1-2 instability and unilateral VA occlusion, in order to reduce the risk of further VA injury.

Clinical presentation

A 64-year-old woman with rheumatoid atlantoaxial subluxation complained of cervical myelopathy and neck pain. Preoperative MR angiography showed a left side VA occlusion.

Technique

The patient underwent atlantoaxial, posterior fusion using a transarticular screw on the side of the occlusion and a C2 laminar screw on the dominant side combined with a bilateral atlas hook. The transarticular screw was inserted using a navigation system and image intensifier, and the laminar screw was inserted free hand. Bone grafting from the iliac crest was performed.

Conclusion

Transarticular and C2 laminar screws fixation combined with the atlas hook in a patient with unilateral VA occlusion is a useful technique, in order to reduce the risk of further VA injury.
Literature
1.
Brooks AL, Jenkins EB (1978) Atlanto-axial arthrodesis by the wedge compression method. J Bone Joint Surg Am 60:279–284PubMed
2.
Coyne TJ, Fehlings MG, Wallace MC, Bernstein M, Tator CH (1995) C1–C2 posterior cervical fusion: long-term evaluation of results and efficacy. Neurosurgery 37:688–693PubMedCrossRef
3.
Gallie W (1939) Fractures and dislocations of the cervical spine. Am J Surg 46:495–499CrossRef
4.
Harms J, Melcher RP (2001) Posterior C1–C2 fusion with polyaxial screw and rod fixation. Spine 26:2467–2471PubMedCrossRef
5.
Huang MJ, Glaser JA (2003) Complete arcuate foramen precluding C1 lateral mass screw fixation in a patient with rheumatoid arthritis: case report. Iowa Orthop J 23:96–99PubMed
6.
Louw JA, Mafoyane NA, Small B, Neser CP (1990) Occlusion of the vertebral artery in cervical spine dislocations. J Bone Joint Surg 72–B:679–681
7.
Madawi AA, Casey AT, Solanki GA, Tuite G, Veres R, Crockard HA (1997) Radiological and anatomic evaluation of the atlantoaxial transarticular screw fixation technique. J Neurosurg 86:961–968PubMed
8.
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
9.
Matsubara T, Mizutani J, Fukuoka M, Hatoh T, Kojima H, Otsuka T (2007) Safe atlantoaxial fixation using a laminar screw (intralaminar screw) in a patient with unilateral occlusion of vertebral artery. Spine 32:E30–E33PubMedCrossRef
10.
Menendez JA, Wright NM (2007) Techniques of posterior C1–C2 stabilization. Neurosurgery 60(Suppl 1):S103–S111PubMed
11.
Richter M, Schmidt R, Claes L, Puhl W, Wilke HJ (2002) Posterior atlantoaxial fixation: biomechanical in vitro comparison of six different techniques. Spine 27:1724–1732PubMedCrossRef
12.
Seichi A, Takeshita K, Nakajima S, Akune T, Kawaguchi H, Nakamura K (2005) Revision cervical spine surgery using transarticular or pedicle screws under a computer-assisted image guidance system. J Orthop Sci 10:385–390PubMedCrossRef
13.
Tan M, Wang H, Wang Y, Zhang G, Yi P, Li Z, Wei H, Yang F (2003) Morphometric evaluation of screw fixation in atlas via posterior arch and lateral mass. Spine 28:888–895PubMedCrossRef
14.
Taneichi H, Suda K, Kajino T, Kaneda K (2005) Traumatically induced vertebral artery occlusion associated with cervical spine injuries: prospective study using magnetic resonance angiography. Spine 30:1955–1962PubMedCrossRef
15.
Wright NM (2004) Posterior C2 fixation using bilateral, crossing C2 laminar screws. J Spinal Disord Tech 17:158–162PubMed
16.
Wright NM, Lauryssen C (1998) 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. American association of neurological surgeons/congress of neurological surgeons. J Neurosurg 88:634–640PubMedCrossRef
Metadata
Title
Safety of atlantoaxial fusion using laminar and transarticular screws combined with an atlas hook in a patient with unilateral vertebral artery occlusion (case report)
Authors
Yoshihisa Sugimoto
Masato Tanaka
Kazuo Nakanishi
Haruo Misawa
Tomoyuki Takigawa
Yasuo Ito
Toshifumi Ozaki
Publication date
01-01-2009
Publisher
Springer-Verlag
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 1/2009
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-007-0510-9

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