Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2016 Aug 15;56(8):465-75.
doi: 10.2176/nmc.ra.2015-0342. Epub 2016 Apr 4.

Surgical Intervention for Instability of the Craniovertebral Junction

Masakazu Takayasu  1 , Masahiro Aoyama, Masahiro Joko, Mikinobu Takeuchi
Affiliations
Review

Surgical Intervention for Instability of the Craniovertebral Junction

Masakazu Takayasu et al. Neurol Med Chir (Tokyo). .

Abstract

Surgical approaches for stabilizing the craniovertebral junction (CVJ) are classified as either anterior or posterior approaches. Among the anterior approaches, the established method is anterior odontoid screw fixation. Posterior approaches are classified as either atlanto-axial fixation or occipito-cervical (O-C) fixation. Spinal instrumentation using anchor screws and rods has become a popular method for posterior cervical fixation. Because this method achieves greater stability and higher success rates for fusion without the risk of sublaminar wiring, it has become a substitute for previous methods that used bone grafting and wiring. Several types of anchor screws are available, including C1/2 transarticular, C1 lateral mass, C2 pedicle, and translaminar screws. Appropriate anchor screws should be selected according to characteristics such as technical feasibility, safety, and strength. With these stronger anchor screws, shorter fixation has become possible. The present review discusses the current status of surgical interventions for stabilizing the CVJ.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest Disclosure

The author reports no conflicts of interest concerning the materials or methods used in this study or the findings specified in this article. All authors who are members of The Japan Neurosurgical Society (JNS) have registered online Self-reported COI Disclosure Statement Forms through the website for JNS members.

Figures

Fig. 1.
Fig. 1.
Anterior odontoid screw fixation. A, B: Intraoperative photographs showing biplane image setting (A) and oblique skin incision (B). C, D: Cervical radiograph, anterior-posterior view (C), lateral view (D). E: Midsagittal computed tomography reconstruction. Arrow shows the drilled region of the superior central portion of the C3 vertebral body.
Fig. 2.
Fig. 2.
C1/2 transarticular screw fixation with interlaminar bone grafting and wiring (Magerl’s) method. A: Lateral cervical radiograph, B: three-dimensional computed tomography reconstruction, C: intraoperative photograph.
Fig. 3.
Fig. 3.
C1 lateral mass and C2 pedicle screw fixation (Goel-Harms) method. A: preoperative 3D-CT angiography, showing bilateral vertebral artery fenestration; B: lateral cervical radiograph, C, D: axial CT showing the bilateral C1 lateral mass screws (C) and the C2 pedicle screws (D).
Fig. 4.
Fig. 4.
C1 lateral mass and C2 screw fixation using the translaminar screw (Goel-Harms-Wright method). A–D: Lateral cervical radiograph (A), axial computed tomography showing the bilateral C1 lateral mass screws (B), the C2 pedicle screw (C), and the translaminar screw (D).
Fig. 5.
Fig. 5.
Occipito-cervical fixation using the monoaxial screw and a rod system (Olerud cervical system). A: Intraoperative photographs showing the rod, screws, and offset connectors, B: lateral cervical radiograph.
Fig. 6.
Fig. 6.
Occipito-cervical fixation using the polyaxial screws and rod system. A: Lateral cervical radiograph, B: 3D-CT reconstruction oblique view, and C: posterior view showing grafted bone chips around the screws and rods.
Fig. 7.
Fig. 7.
Occipito-cervical fixation using the polyaxial screw and rod system, using bilateral C2 translaminar screws as the C2 anchor. A: Cervical radiograph lateral view, B: anterior-posterior view. C, D: Axial computed tomography showing bilateral C2 translaminar screws.
See this image and copyright information in PMC

References

    1. Takayasu M, Hara M, Saito K, Yoshida J: Instrumentation for craniovertebral junction lesions. Spinal Surgery 11: 135– 142, 1997. (Japanese)
    1. Takayasu M: Surgical strategies for the craniocervical junction. Jpn J Neurosurg 22: 427– 434, 2013. (Japanese)
    1. Ahmed R, Traynelis VC, Menezes AH: Fusions at the craniovertebral junction. Childs Nerv Syst 24: 1209– 1224, 2008. - PubMed
    1. Clark CR, White AA: Fractures of the dens. A multicenter study. J Bone Joint Surg Am 67: 1340– 1348, 1985. - PubMed
    1. Anderson LD, D’Alonzo RT: Fractures of the odontoid process of the axis. J Bone Joint Surg Am 56: 1663– 1674, 1974. - PubMed