Myelopathy Improvement Following Removal of Cervical Sublaminar Wiring

Novel Technique for C1-2 Interlaminar Arthrodesis Utilizing a Modified Sonntag Loop-Suture Graft With Posterior C1-2 Fixation

Objective

Conventional techniques for atlantoaxial fixation and fusion typically pass cables or wires underneath C1 lamina to secure the bone graft between the posterior elements of C1–2, which leads to complications such as cerebrospinal fluid (CSF) leak and neurological injury. With the evolution of fixation hardware, we propose a novel C1–2 fixation technique that avoids the morbidity and complications associated with sublaminar cables and wires.

Methods

This technique entails wedging and anchoring a structural iliac crest graft between C1 and C2 for interlaminar arthrodesis and securing it using a 0-Prolene suture at the time of C1 lateral mass and C2 pars interarticularis screw fixation.

Results

We identified 32 patients who underwent surgery for atlantoaxial with our technique. A 60% improvement in pain-related disability from preoperative baseline was demonstrated by Neck Disability Index (p<0.001). There were no neurologic deficits. Complications included 2 patients CSF leaks related to presenting trauma, 1 patient with surgical site infection, and 1 patient with transient dysphagia. The rate of radiographic atlantoaxial fusion was 96.8% at 6 months, with no evidence of instrumentation failure, graft dislodgement, or graft related complications.

Conclusion

We demonstrate a novel technique for C1–2 arthrodesis that is a safe and effective option for atlantoaxial fusion.

The Use of Sublaminar Wiring in the Sub-Axial Cervical Spine as an Adjuvant to Lateral Mass and Pedicle Screw Fixation in a Patient with Metastatic Carcinoma of the Upper Thoracic Spine

A 60-year-old male presented with kyphotic deformity caused by a non-small cell lung cancer metastasis in the cervical-thoracic junction. His pathology caused spinal cord compression and segmental instability. The patient underwent a posterior decompression to try and improve neurological function as well as posterior lateral mass and pedicle screw fixation crossing the cervical-thoracic junction to stabilize his instability. A novel technique incorporating sublaminar wiring across a cross-link was utilized to increase pull out strength of the superior lateral mass screws. Also included is a discussion regarding the safe use of sublaminar wires, the history of posterior cervical and thoracic fusion, and the prevalence of instrumentation failure.