CLINICAL APPLICATION OF ATLAS TRANSLAMINAR SCREWS FIXATION IN TREATMENT OF ATLATOAXIAL INSTABILITY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Guoyou , FU Shijie , SHEN Huarui , GUAN Taiyuan , XU Ping.

Department of Orthopaedics, Traditional Chinese Medicine Hospital Affiliated to Luzhou Medical College, Luzhou Sichuan, 646000, P.R.China. Corresponding author: FU Shijie, E-mail: fu_fsj@sina.com;

Corresponding author：

Keywords：

Atlatoaxial instability; Translaminar screw; Internal fixation

DOI：

10.7507/1002-1892.20130265

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Objective To explore the effectiveness of fixation of atlas translaminar screws in the treatment of atlatoaxial instability. Methods A retrospective analysis was made on the clinical data of 32 patients with atlatoaxial instability treated with atlantoaxial trans-pedicle screws between March 2007 and August 2009. Of them, 7 patients underwent atlas translaminar screws combined with axis transpedicle screws fixation because of fracture types, anatomic variation, and intraoperative reason, including 5 males and 2 females with an average age of 48.2 years (range, 35-69 years). A total of 9 translaminar screws were inserted. Injury was caused by traffic accident in 4 cases, falling from height in 2 cases, and crushing in 1 case. Two cases had simple odontoid fracture (Anderson type II), and 5 cases had odontoid fracture combined with other injuries (massa lateralis atlantis fracture in 2, atlantoaxial dislocation in 1, and Hangman fracture in 2). The interval between injury and operation was 4-9 days (mean, 6 days). The preoperative Japanese Orthopaedic Association (JOA) score was 8.29 ± 1.60. Results The X-ray films showed good position of the screws. Healing of incision by first intention was obtained, and no patient had injuries of the spinal cord injury, nerve root, and vertebral artery. Seven cases were followed up 9-26 months (mean, 14 months). Good bone fusion was observed at 8 months on average (range, 6-11 months). No loosening, displacement, and breakage of internal fixation, re-dislocation and instability of atlantoaxial joint, or penetrating of pedicle screw into the spinal canal and the spinal cord occurred. The JOA score was significantly improved to 15.29 ± 1.38 at 6 months after operation (t=32.078, P=0.000). Conclusion Atlas translaminar screws fixation has the advantages of firm fixation, simple operating techniques, and relative safety, so it may be a remedial measure of atlatoaxial instability．

Citation： WANG Guoyou,FU Shijie,SHEN Huarui,GUAN Taiyuan,XU Ping.. CLINICAL APPLICATION OF ATLAS TRANSLAMINAR SCREWS FIXATION IN TREATMENT OF ATLATOAXIAL INSTABILITY. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(10): 1210-1213. doi: 10.7507/1002-1892.20130265 Copy

1.	王雷, 田纪伟, 董双海, 等. C1/2椎弓根固定技术在寰枢椎复杂骨折中的应用. 中华医学杂志, 2012, 92(11): 760-763.
2.	Resnick DK, Lapsiwale S, Toost GR. Anatomic suitability of the C1- C2 complex for pedicle screw fixation. Spine (Phila Pa 1976), 2002, 27(14): 1494-1498.
3.	谭明生, 蒋欣. 寰枢椎脱位的外科治疗原则. 中国脊柱脊髓杂志, 2012, 22(2): 103-105.
4.	Floyd T, Grob D. Translaminar screws in the atlas. Spine (Phila Pa 1976), 2000, 25(22): 2913-2915.
5.	Baaj AA, Vrionis FD. Atlantoaxial stabilization utilizing atlas translaminar fixation. J Clin Neurosci, 2010, 17(12): 1578-1580.
6.	Riesenburger RI, Jones GA, Roguski M, et al. Risk to the vertebral artery during C-2 translaminar screw placement: a thin-cut computerized tomography angiogram-based morphometric analysis. J Neurosurg Spine, 2013, 19(2): 217-221.
7.	Mammis A, Yanni DS, Thaker NG, et al. Reduction of displaced Hangman’s fracture by compression across crossed translaminar screws. J Clin Neurosci, 2012, 19(4): 582-584.
8.	Yusof MI, Shamsi SS. Translaminar screw fixation of the cervical spine in Asian population: feasibility and safety consideration based on computerized tomographic measurements. Surg Radiol Anat, 2012, 34(3): 203-207.
9.	覃炜, 权正学, 欧云生, 等. 颈后路椎弓根螺钉内固定术治疗寰枢椎不稳及脱位. 中国修复重建外科杂志, 2010, 24(2): 202-205.
10.	Ringel F, Reinke A, Stüer C, et al. Posterior C1-2 fusion with C1 lateral mass and C2 isthmic screws: accuracy of screw position, alignment and patient outcome. Acta Neurochir (Wien), 2012, 154(2): 305-312.
11.	Jacobson ME, Khan SN, An HS. C1-C2 posterior fixation: indications, technique, and results. Orthop Clin North Am, 2012, 43(1): 11-18.
12.	Goel A, Desai KI, Muzumdar DP. Atlantoaxial fixation using plate and screw method: a report of 160 treated patients. Neurosurgery, 2002, 51(6): 1351-1357.
13.	Harms J, Melcher RP. Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976), 2001, 26(22): 2467-2471.
14.	Lehman RA Jr, Dmitriev AE, Wilson KW. Biomechanical analysis of the C2 intralaminar fixation technique using a cross-link and offset connect or for an unstable atlantoaxial joint. Spine (Phila Pa 1976), 2012, 12(2): 151-156.
15.	Zhou F, Ni B, Li S, et al. C2 translaminar screw as the optimal choice for atlantoaxial dislocation with C2-C3 congenital fusion. Arch Orthop Trauma Surg, 2010, 130(12): 1505-1509.
16.	金国鑫, 王欢, 李雷, 等. 寰椎后弓螺钉交叉固定的解剖学研究. 中华骨科杂志, 2012, 32(1): 65-69.
17.	何帆, 尹庆水, 马向阳. 寰椎后弓形态分类与椎弓螺钉固定的解剖学研究. 中国临床解剖学杂志, 2006, 24(3): 275-278.

1. 王雷, 田纪伟, 董双海, 等. C1/2椎弓根固定技术在寰枢椎复杂骨折中的应用. 中华医学杂志, 2012, 92(11): 760-763.
2. Resnick DK, Lapsiwale S, Toost GR. Anatomic suitability of the C1- C2 complex for pedicle screw fixation. Spine (Phila Pa 1976), 2002, 27(14): 1494-1498.
3. 谭明生, 蒋欣. 寰枢椎脱位的外科治疗原则. 中国脊柱脊髓杂志, 2012, 22(2): 103-105.
4. Floyd T, Grob D. Translaminar screws in the atlas. Spine (Phila Pa 1976), 2000, 25(22): 2913-2915.
5. Baaj AA, Vrionis FD. Atlantoaxial stabilization utilizing atlas translaminar fixation. J Clin Neurosci, 2010, 17(12): 1578-1580.
6. Riesenburger RI, Jones GA, Roguski M, et al. Risk to the vertebral artery during C-2 translaminar screw placement: a thin-cut computerized tomography angiogram-based morphometric analysis. J Neurosurg Spine, 2013, 19(2): 217-221.
7. Mammis A, Yanni DS, Thaker NG, et al. Reduction of displaced Hangman’s fracture by compression across crossed translaminar screws. J Clin Neurosci, 2012, 19(4): 582-584.
8. Yusof MI, Shamsi SS. Translaminar screw fixation of the cervical spine in Asian population: feasibility and safety consideration based on computerized tomographic measurements. Surg Radiol Anat, 2012, 34(3): 203-207.
9. 覃炜, 权正学, 欧云生, 等. 颈后路椎弓根螺钉内固定术治疗寰枢椎不稳及脱位. 中国修复重建外科杂志, 2010, 24(2): 202-205.
10. Ringel F, Reinke A, Stüer C, et al. Posterior C1-2 fusion with C1 lateral mass and C2 isthmic screws: accuracy of screw position, alignment and patient outcome. Acta Neurochir (Wien), 2012, 154(2): 305-312.
11. Jacobson ME, Khan SN, An HS. C1-C2 posterior fixation: indications, technique, and results. Orthop Clin North Am, 2012, 43(1): 11-18.
12. Goel A, Desai KI, Muzumdar DP. Atlantoaxial fixation using plate and screw method: a report of 160 treated patients. Neurosurgery, 2002, 51(6): 1351-1357.
13. Harms J, Melcher RP. Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976), 2001, 26(22): 2467-2471.
14. Lehman RA Jr, Dmitriev AE, Wilson KW. Biomechanical analysis of the C2 intralaminar fixation technique using a cross-link and offset connect or for an unstable atlantoaxial joint. Spine (Phila Pa 1976), 2012, 12(2): 151-156.
15. Zhou F, Ni B, Li S, et al. C2 translaminar screw as the optimal choice for atlantoaxial dislocation with C2-C3 congenital fusion. Arch Orthop Trauma Surg, 2010, 130(12): 1505-1509.
16. 金国鑫, 王欢, 李雷, 等. 寰椎后弓螺钉交叉固定的解剖学研究. 中华骨科杂志, 2012, 32(1): 65-69.
17. 何帆, 尹庆水, 马向阳. 寰椎后弓形态分类与椎弓螺钉固定的解剖学研究. 中国临床解剖学杂志, 2006, 24(3): 275-278.

Chinese Journal of Reparative and Reconstructive Surgery

CLINICAL APPLICATION OF ATLAS TRANSLAMINAR SCREWS FIXATION IN TREATMENT OF ATLATOAXIAL INSTABILITY

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