Posterior Instrumentation Surgery for Craniocervical Junction Instabilities: an Update

The New Alternative Technique Outcomes: Atlas Lateral Mass Screw and C2-3 Transfacet Screw Fixation for Complex Atlantoaxial Instability in Patients with Thin C2 Pedicle or High-Riding Vertebral Artery

OBJECTIVE

The study aimed to evaluate the safety, feasibility, effect on fusion, and clinical efficacy of atlas lateral mass and C2-3 transfacet screw fixation technique, serves as an alternative method to traditional posterior atlantoaxial fixation.

METHODS

Patients with atlantoaxial instability who underwent atlas lateral mass and C2-3 transfacet fixation surgery were included. The duration of the surgery and the quantity of blood lost during the operation were recorded. Patients were monitored via X-ray and computed tomography scans to evaluate the degree of fusion at the 1-month and 12-month follow-up. The Neck Visual Analog Scale and Neck Disability Index were evaluated preoperatively, in the postoperative first week, and at the 12-month follow-up for clinical follow-up.

RESULTS

A total of 8 patients with atlantoaxial instability due to odontoid fracture or Arnold- Chiari malformation accompanied by bony or vascular abnormalities were included in the study between 2017 and 2024. All 8 patients underwent successful atlas lateral mass and C2-3 transfacet screw fixation, with no neurovascular injury noted during surgery. All patients with fracture exhibited fusion at the 12-month mark, and both the Neck Visual Analog Scale and Neck Disability Index scores demonstrated significant improvement at both the 1-week and 12-month postoperative periods (P < 0.05).

CONCLUSIONS

The atlas lateral mass and C2-3 transfacet screw fixation technique, an alternative to conventional posterior fixation, has been demonstrated to be an efficacious method for providing adequate stabilization and fusion in patients with atlantoaxial instability, even in the cases of thin C2 pedicle, high-riding vertebral artery, previous failed surgeries, or reoperation.

Incidence of vertebral artery injury in patients undergoing cervical spine trauma surgery in correlation with surgical approach: A review

Spinal cord injuries at the cervical spine level represent the most consequential of the related injuries at all levels of the spine. They can trigger permanent unilateral or bilateral damage with conspicuous disability. Regarding unstable injuries, the gold standard approach is open reduction and osteosynthesis, which can select between anterior and posterior surgical access. Each of the aforementioned approaches demonstrates both advantages and disadvantages; thus, it is up to the surgeon to determine the optimal option concerning the patient's safety. Diligent intraoperative control of anatomical reduction is pivotal to obtaining the best feasible postoperative outcomes. Literature data delineate copious complications following surgical intervention in the cervical spine. Indubitably, the most crucial intraoperative complication accounts for vascular injuries, with the most preponderant being the corrosion of the vertebral artery, as it is potentially life-threatening. This paper aims to provide a succinct and compendious review of the existing literature regarding cervical spinal cord injuries and to deduce many inferences concerning the incidence of iatrogenic vertebral artery injuries in relation to the surgical approach for fracture reduction.

Ligaments of the craniocervical junction

The specialized ligaments of the craniocervical junction must allow for stability yet functional movement. Because injury to these important structures usually results in death or morbidity, the neurosurgeon should possess a thorough understanding of the anatomy and function of these ligaments. To the authors' knowledge, a comprehensive review of these structures is not available in the medical literature. The aim of the current study was to distill the available literature on each of these structures into one offering.

Use of screw-rod system in occipitocervical fixation

BACKGROUND

This study retrospectively reviewed 9 patients who underwent occipitocervical fixation with a newly developed screw-rod fixation system between April 2004 and November 2005. The objective was to evaluate the clinical result of occipitocervical fixation with the screw-rod fixation system, including symptom relief, fusion rate and complications.

METHODS

All 9 patients received occipitocervical fixation surgery with screw-rod fixation system and autologous bone grafts for fusion. Fusion was assessed by plain cervical X-ray films, and the myelopathy by Nurick scale.

RESULTS

Four males and 5 females were enrolled into this study. Mean age was 58.8 years, and mean follow-up period was 15 months. One female patient experienced surgical site infection with instrument pullout 20 months after surgery; she received a second operation for instrument revision. The overall fusion rate was 100%. The mean Nurick scores were 3 preoperatively and 2.1 postoperatively, with advancement of 0.9 points on average. Seven of 9 patients experienced pain or myelopathy improvement. There were no complications except for the 1 infection mentioned above.

CONCLUSION

The fusion rate, complication rate and improvement in neurological function of occipitocervical fixation surgery using the screw-rod system were comparable to those of the widely used wire-rod system and screw-plate system.