| Title | Cable-Strengthened C2 Pedicle Screw Fixation in the Treatment of Congenital C2-3 Fusion, Atlas Occipitalization, and Atlantoaxial Dislocation |
| Authors | Wang, Shenglin Wang, Chao Leng, Huijie Zhao, Weidong Yan, Ming Zhou, Haitao |
| Affiliation | Peking Univ, Hosp 3, Dept Orthopaed, Beijing 100191, Peoples R China. So Med Univ, Dept Med Biomech Res, Guangzhou, Guangdong, Peoples R China. Peking Univ, Hosp 3, Dept Orthopaed, 49 N Garden St, Beijing 100191, Peoples R China. |
| Keywords | Atlantoaxial dislocation Basilar invagination C2-3 congenital fusion Cable Occipitalization Pedicle screw Surgery KLIPPEL-FEIL PATIENT OCCIPITOCERVICAL FIXATION BIOMECHANICAL EVALUATION CLASSIFICATION JUNCTION SPINE |
| Issue Date | 2012 |
| Publisher | neurosurgery |
| Citation | NEUROSURGERY.2012,71,(5),976-984. |
| Abstract | BACKGROUND: Atlas occipitalization and congenital C2-3 fusion often result in atlantoaxial dislocation (AAD) and superior odontoid migration that requires occipitocervical fixation. The widely used technique is posterior occiput-C2 fixation with pedicle screws. However, congenital C2-3 fusion cases tend to have thinner C2 pedicles that are inadequate for normal-sized pedicle screw fixation. With the presence of AAD, the strength of the fixation is further compromised as the C2 pedicle screws (C2PS) sustain considerable cephalic shearing force during the reduction procedure. Therefore, a novel technique has been developed to augment the C2 pedicle screw fixation with a strengthening cable. OBJECTIVE: To introduce and assess this new technique. METHODS: Seventy-six patients who underwent this procedure were reviewed. The position of the instrument and resultant fusion were examined retrospectively. In the biomechanical test, 6 fresh specimens were subjected to 2 types of fixation in the order of Oc-C2 screw-plate fixation followed by additional use of strengthening cable. Under 3 loading modes (extension-flexion, lateral bending, and axial rotation), the relative movement between the occiput and C2 was measured and compared in the form of range of motion. RESULTS: The average follow-up time was 26 months. Solid fusion was achieved in 75 patients (98.7%) as assessed radiologically. The only patient who experienced hardware failure eventually obtained solid fusion between the occiput and C2 after revision. Biomechanically, there was significant difference between the occiput and C2 fixation and cable-strengthened fixation in range of motion for all modes. CONCLUSION: This technique is a promising option for the treatment of AAD with congenital C2-3 fusion and occipitalization. Biomechanically, this technique can reduce the occipital-axial motion significantly compared with occiput-C2 fixation. |
| URI | http://hdl.handle.net/20.500.11897/309377 |
| ISSN | 0148-396X |
| DOI | 10.1227/NEU.0b013e31826cdd3b |
| Indexed | SCI(E) PubMed |
| Appears in Collections: | 第三医院 |
