Journal of Korean Neurosurgical Society

  • 제57권6호
  • /
  • Pages.460-464
  • /
  • 2015
  • /
  • 2005-3711(pISSN)
  • /
  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
권호 표지
DOI QR코드

DOI QR Code

Unilateral C1 Lateral Mass and C2 Pedicle Screw Fixation for Atlantoaxial Instability in Rheumatoid Arthritis Patients : Comparison with the Bilateral Method

  • Paik, Seung-Chull (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Chun, Hyoung-Joon (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Bak, Koang Hum (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Ryu, Jeil (Department of Neurosurgery, Guri Hanyang Hospital) ;
  • Choi, Kyu-Sun (Department of Neurosurgery, Guri Hanyang Hospital)
  • 투고 : 2015.02.10
  • 심사 : 2015.04.10
  • 발행 : 2015.06.28
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective : Bilateral C1 lateral mass and C2 pedicle screw fixation (C1LM-C2P) is an ideal technique for correcting atlantoaxial instability (AAI). However, the inevitable situation of vertebral artery injury or unfavorable bone structure may necessitate the use of unilateral C1LM-C2P. This study compares the fusion rates of the C1 lateral mass and C2 pedicle screw in the unilateral and bilateral methods. Methods : Over five years, C1LM-C2P was performed in 25 patients with AAI in our institute. Preoperative studies including cervical X-ray, three-dimensional computed tomography (CT), CT angiogram, and magnetic resonance imaging were performed. To evaluate bony fusion, measurements of the atlanto-dental interval (ADI) and CT scans were performed in the preoperative period, immediate postoperative period, and postoperatively at 1, 3, 6, and 12 months. Results : Unilateral C1LM-C2P was performed in 11 patients (44%). The need to perform unilateral C1LM-C2P was due to anomalous course of the vertebral artery in eight patients (73%) and severe degenerative arthritis in three patients (27%). The mean ADI in the bilateral group was 2.09 mm in the immediate postoperative period and 1.75 mm in 12-months postoperatively. The mean ADI in the unilateral group was 1.82 mm in the immediate postoperative period and 1.91 mm in 12-months postoperatively. Comparison of ADI measurements showed no significant differences in either group (p=0.893), and the fusion rate was 100% in both groups. Conclusion : Although bilateral C1LM-C2P is effective for AAI from a biomechanical perspective, unilateral screw fixation is a useful alternative in patients with anatomical variations.

키워드

참고문헌

  1. Abou Madawi A, Solanki G, Casey AT, Crockard HA : Variation of the groove in the axis vertebra for the vertebral artery. Implications for instrumentation. J Bone Joint Surg Br 79 : 820-823, 1997 https://doi.org/10.1302/0301-620X.79B5.7566
  2. Coyne TJ, Fehlings MG, Wallace MC, Bernstein M, Tator CH : C1-C2 posterior cervical fusion : long-term evaluation of results and efficacy. Neurosurgery 37 : 688-692; discussion 692-693, 1995 https://doi.org/10.1227/00006123-199510000-00012
  3. Gautschi OP, Payer M, Corniola MV, Smoll NR, Schaller K, Tessitore E : Clinically relevant complications related to posterior atlanto-axial fixation in atlanto-axial instability and their management. Clin Neurol Neurosurg 123 : 131-135, 2014 https://doi.org/10.1016/j.clineuro.2014.05.020
  4. Goel A, Desai KI, Muzumdar DP : Atlantoaxial fixation using plate and screw method : a report of 160 treated patients. Neurosurgery 51 : 1351-1356; discussion 1356-1357, 2002 https://doi.org/10.1227/01.NEU.0000309110.78968.F5
  5. Goel A, Laheri V : Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir (Wien) 129 : 47-53, 1994 https://doi.org/10.1007/BF01400872
  6. Harms J, Melcher RP : Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976) 26 : 2467-2471, 2001 https://doi.org/10.1097/00007632-200111150-00014
  7. Hue YH, Chun HJ, Yi HJ, Oh SH, Oh SJ, Ko Y : Unilateral posterior atlantoaxial transarticular screw fixation in patients with atlantoaxial instability : comparison with bilateral method. J Korean Neurosurg Soc 45 : 164-168, 2009 https://doi.org/10.3340/jkns.2009.45.3.164
  8. Jeanneret B, Magerl F : Primary posterior fusion C1/2 in odontoid fractures : indications, technique, and results of transarticular screw fixation. J Spinal Disord 5 : 464-475, 1992 https://doi.org/10.1097/00002517-199212000-00012
  9. Kim JY, Oh CH, Yoon SH, Park HC, Seo HS : Comparison of outcomes after atlantoaxial fusion with transarticular screws and screw-rod constructs. J Korean Neurosurg Soc 55 : 255-260, 2014 https://doi.org/10.3340/jkns.2014.55.5.255
  10. Kuroki H, Rengachary SS, Goel VK, Holekamp SA, Pitkanen V, Ebraheim NA : Biomechanical comparison of two stabilization techniques of the atlantoaxial joints : transarticular screw fixation versus screw and rod fixation. Neurosurgery 56 (1 Suppl) : 151-159; discussion 151-159, 2005
  11. Liu G, Buchowski JM, Shen H, Yeom JS, Riew KD : The feasibility of microscope-assisted "free-hand" C1 lateral mass screw insertion without fluoroscopy. Spine (Phila Pa 1976) 33 : 1042-1049, 2008 https://doi.org/10.1097/BRS.0b013e31816d72b5
  12. Neo M, Matsushita M, Iwashita Y, Yasuda T, Sakamoto T, Nakamura T : Atlantoaxial transarticular screw fixation for a high-riding vertebral artery. Spine (Phila Pa 1976) 28 : 666-670, 2003
  13. Nottmeier EW, Foy AB : Placement of C2 laminar screws using three-dimensional fluoroscopy-based image guidance. Eur Spine J 17 : 610-615, 2008 https://doi.org/10.1007/s00586-007-0557-x
  14. Paramore CG, Dickman CA, Sonntag VK : The anatomical suitability of the C1-2 complex for transarticular screw fixation. J Neurosurg 85 : 221-224, 1996 https://doi.org/10.3171/jns.1996.85.2.0221
  15. Payer M, Luzi M, Tessitore E : Posterior atlanto-axial fixation with polyaxial C1 lateral mass screws and C2 pars screws. Acta Neurochir (Wien) 151 : 223-229; discussion 229, 2009 https://doi.org/10.1007/s00701-009-0198-4
  16. Tessitore E, Bartoli A, Schaller K, Payer M : Accuracy of freehand fluoroscopy-guided placement of C1 lateral mass and C2 isthmic screws in atlanto-axial instability. Acta Neurochir (Wien) 153 : 1417-1425; discussion 1425, 2011 https://doi.org/10.1007/s00701-011-1039-9
  17. van de Kraats EB, van Walsum T, Kendrick L, Noordhoek NJ, Niessen WJ : Accuracy evaluation of direct navigation with an isocentric 3D rotational X-ray system. Med Image Anal 10 : 113-124, 2006 https://doi.org/10.1016/j.media.2005.04.012
  18. van de Kraats EB, van Walsum T, Verlaan JJ, Voormolen MH, Mali WP, Niessen WJ : Three-dimensional rotational X-ray navigation for needle guidance in percutaneous vertebroplasty : an accuracy study. Spine (Phila Pa 1976) 31 : 1359-1364, 2006 https://doi.org/10.1097/01.brs.0000218580.54036.1b
  19. Verlaan JJ : Placement of C2 laminar screws using three-dimensional fluoroscopy-based image guidance by Eric W. Nottmeier and Andrew B. Foy. Eur Spine J 17 : 616-617, 2008 https://doi.org/10.1007/s00586-007-0574-9
  20. Wright NM, Lauryssen C : Vertebral artery injury in C1-2 transarticular screw fixation : results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves. American Association of Neurological Surgeons/Congress of Neurological Surgeons. J Neurosurg 88 : 634-640, 1998 https://doi.org/10.3171/jns.1998.88.4.0634
  21. Xie Y, Li Z, Tang H, Li M, Guan Z : Posterior C1 lateral mass and C2 pedicle screw internal fixation for atlantoaxial instability. J Clin Neurosci 16 : 1592-1594, 2009 https://doi.org/10.1016/j.jocn.2009.03.026

피인용 문헌

  1. Novel unilateral C1 double screw and ipsilateral C2 pedicle screw placement combined with contralateral laminar screw-rod fixation for atlantoaxial instability vol.28, pp.2, 2015, https://doi.org/10.1007/s00586-018-5853-0
  2. Unilateral lag screw fixation of isolated non-union atlas lateral mass fracture: a new technical note vol.33, pp.2, 2015, https://doi.org/10.1080/02688697.2018.1426727