C1-2 posterior arthrodesis technique with a left segmental and right transarticular fixation. A hybrid novel (Kotil) technique

Abstract

Introduction: The most commonly used techniques for C1-C2 posterior arthrodesis are Goel and Magerl fixation techniques. Due to the anatomical variations of the region, the prior determination of the surgical technique might be hard. Right side Magerl, left side Goel's C1-C2 posterior arthrodesis case is presented as a new surgical combination technique used due to anatomical difficulties.

Materials and methods: Posterior C1-C2 arthrodesis operation was indicated for a 56-year-old female patient for the treatment of atlanto-axial subluxation caused by os odontoideum. First it was fixed from the nondominant arterial side (right vertebral artery) with Magerl (transarticular) technique. The left side was not suitable for the anatomical transarticular fixation, and the contralateral Goel fixation technique (segmental) was performed. Eventually, right side transarticular left side segmental fixation techniques were combined in one patient for the first time and C1-C2 fusion combination technique was presented.

Results: Both Goel and Magerl techniques of C1-C2 posterior fusion techniques were successfully used simultaneously. The operation was initiated with Magerl technique with one screw on the nondominant side. The contralateral side was not suitable for Magerl technique therefore we changed to Goel's technique. Although, fluoroscopy was used 3 times as much during the introduction of the Drill with Magerl technique, twice as much operative time was spent during hemostasis and bleeding, preparation of the C1 entry point, and the reconstruction of polyaxial screws for Goel technique. No neurovascular complications were occurred during both procedures.

Discussion: Combination of two C1-C2 posterior fusion techniques, Goel and Magerl, in suitable cases caused by anatomical or other reasons appears to be an alternative surgical procedure that protects the patient from complications. For a collection of better data, other studies that include large numbers of patients with high evidential value should be conducted.

Keywords: C1-C2 posterior arthrodesis; Kotil technique; novel technique; segmental fixation; transarticular fixation.

Figure 1

(a) The direct X-ray lateral graphy imaging of the cervical spine showing a ponticulus posticus (arrow) anomaly of C1. (b) Sagittal computed tomography was showing an os odontoiedum. (c) T2-weighted sagittal magnetic resonance imaging of the cervical spine showing hyperintense signal

Figure 2

Postoperative direct X-ray posterior-anterior (a) and coronal computed tomography (b) imaging of the upper cervical spine showing both segmental and transarticular screws

Figure 3

The illustration imaging of the C1-C2 spine showing to try and reduce the atlantodental distance thick spiral silk sutures passing under laminae of C1 and C2 before fixation process were used

Figure 4

The illustration imaging of the C1-C2 spine showing an auto graft harvested from iliac crest was tightened with sutures of number 0 silk thread over spiral sutures passing under laminae between laminae of decorticated C1 and C2 and posterior arthrodesis was performed