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Case Reports
. 2016;39(2):234-9.
doi: 10.1179/2045772314Y.0000000298. Epub 2016 Feb 11.

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

Ai-Min Wu  1 , Xiang-Yang Wang  1 , Feng Zhou  1 , Xiao-Lei Zhang  1 , Hua-Zi Xu  1 , Yong-Long Chi  1
Affiliations
Case Reports

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

Ai-Min Wu et al. J Spinal Cord Med. 2016.

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.

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Figures

Figure 1
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
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.
See this image and copyright information in PMC

References

    1. Dickman CA, Sonntag VK. Posterior C1-C2 transarticular screw fixation for atlantoaxial arthrodesis. Neurosurgery 1998;43(2):275–80; discussion 280–1. doi: 10.1097/00006123-199808000-00056 - DOI - PubMed
    1. Fuji T, Oda T, Kato Y, Fujita S, Tanaka M. Accuracy of atlantoaxial transarticular screw insertion. Spine (Phila Pa 1976) 2000;25(14):1760–4. doi: 10.1097/00007632-200007150-00004 - DOI - PubMed
    1. Weidner A, Wahler M, Chiu ST, Ullrich CG. Modification of C1-C2 transarticular screw fixation by image-guided surgery. Spine (Phila Pa 1976) 2000;25(20):2668–73; discussion 2674. doi: 10.1097/00007632-200010150-00020 - DOI - PubMed
    1. Elgafy H, Potluri T, Goel VK, Foster S, Faizan A, Kulkarni N. Biomechanical analysis comparing three C1-C2 transarticular screw salvaging fixation techniques. Spine (Phila Pa 1976) 2010;35(4):378–85. doi: 10.1097/BRS.0b013e3181bc9cb5 - DOI - PubMed
    1. Lau SW, Sun LK, Lai R, Luk MS, Ng YS, Wong NM, et al. Study of the anatomical variations of vertebral artery in C2 vertebra with magnetic resonance imaging and its application in the C1-C2 transarticular screw fixation. Spine (Phila Pa 1976) 2010;35(11):1136–43. - PubMed

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