Percutaneous atlantoaxial anterior transarticular screw fixation combined with mini-open posterior C1/2 wire fusion for patients with a high-riding vertebral artery

Abstract

Context/objective: To describe the technique and clinical results of percutaneous atlantoaxial anterior transarticular fixation combined with limited exposure posterior C1/2 arthrodesis in patients with a high-riding vertebral artery.

Design setting: Zhejiang Spine Center, China.

Participants: Five patients with a high-riding vertebral artery and an upper cervical fracture.

Interventions: Percutaneous atlantoaxial anterior transarticular screw fixation combined with limited exposure posterior C1/2 wire fusion.

Outcome measures: Computed tomography scans were used to assess the high-riding vertebral artery and feasibility of anterior transarticular screw fixation preoperatively. A Philadelphia collar was used to immobilize the neck postoperatively. Anteroposterior (open-mouth) and lateral views were obtained at pre/postoperation and at the follow-up.

Results: The operation was performed successfully on all of the patients, and no intraoperative operation-related complications such as nerve injury, vertebral artery, and soft tissue complications occurred. The mean follow-up period was 33.8 months (range: 24 to 58 months). No screw breakage, loosening, pullout, or cutout was observed. Bone union was achieved in all patients at the last follow-up.

Conclusions: Our small case series results suggested that percutaneous anterior transarticular screw fixation combined with mini-open posterior C1/2 wire fusion is a technically minimally invasive, safe, feasible, and useful method to treat patients with a high-riding vertebral artery.

Keywords: Anterior transarticular screw fixation; Gallie fusion; High-riding vertebral artery; Minimally invasive; Percutaneous.

Figure 1

Photographs showing the percutaneous atlantoaxial anterior transarticular screw fixation procedure. A, B: A 1.2-mm Kirschner wire with a sharp tip was inserted inside the guide tube, which was aimed toward the center of the lateral mass. C, D: Two 3.5-mm cannulated screws were inserted over the K-wire, inside of the protective tube.

Figure 2

A, B: Preoperative CT showing a Jefferson fracture and a rupture of the transverse ligament of one patient. C–E: The postoperative CT 3D reconstruction by atlantoaxial anterior transarticular screw fixation and C1/2 wire fusion. F, G: The anteroposterior and lateral views at the last follow-up. Bone union was achieved; no screw breakage, loosening, pullout, or cutout was observed.