Placement of bone graft between dorsal arch of C1 and spinous process of C2
Secured by sublaminar wires
Single midline point of fixation → poor stabilization with rotation
Halo required for postoperative immobilization
Brooks fusion (1979)
Bilateral interlaminar bone grafts, secured by bilateral sublaminar wires
Tightening wires will increase compression of grafts
More rotational stability than Gallie method
Locksley method uses 3-point fixation with bilateral autograft attached with sublaminar wires, tightened in "figure 8" pattern
Addition of midline plate attached by wires to posterior spinous processes
Halifax clamp (1975)
Claw-type construct allowing immediate fixation without risk of sublaminar wires
Bone graft placed in interlaminar spaces bilaterally
Requires intact arch of C1
Sublaminar wire in cervical spine associated with 7-17% risk of neurologic injury
Without sublaminar wires
Magerl transarticular screwfixation (1987)
Provides biomechanical stability, particularly against rotational motion and lateral bending
Immediate stabilization by C1-C2 transarticular lateral mass screws
↑ fusion rate (> 90%)
No need for postoperative immobilization
Decreased malalignment
Meticulous operative planning/navigation required to miss vertebral artery (VA) with screws
4-6% VA injury rate
20% of patients have anatomy that precludes transarticular placement
Screw and rod fixation (Harms, 2001)
Lateral mass screws at C1, with pedicle/pars screws at C2 secured by rods bilaterally
No structural grafting or wiring required
VA injury risk similar to that of transarticular screws
Can be performed in patients with body habitus/anatomy unfavorable to transarticular screw
C2 translaminar screws
↓ risk of VA injury
No challenges related to body habitus
↑ pseudoarthrosis rate
↓ rigidity of fixation
PRE-PROCEDURE
Indications
Contraindications
Pre-Procedure Imaging
OUTCOMES
Complications
Selected References
Denaro V et al: The best surgical treatment for type II fractures of the dens is still controversial. Clin Orthop Relat Res. 469(3):742-50, 2011
Bahadur R et al: Transarticular screw fixation for atlantoaxial instability - modified Magerl's technique in 38 patients. J Orthop Surg Res. 5:87, 2010
Conroy E et al: C1 lateral mass screw-induced occipital neuralgia: a report of two cases. Eur Spine J. 19(3):474-6, 2010
Lall R et al: A review of complications associated with craniocervical fusion surgery. Neurosurgery. 67(5):1396-402; discussion 1402-3, 2010
Ma W et al: Clinical application of C2 laminar screw technique. Eur Spine J. 19(8):1312-7, 2010
Ni B et al: Bilateral C1 laminar hooks combined with C2 pedicle screws fixation for treatment of C1-C2 instability not suitable for placement of transarticular screws. Eur Spine J. 19(8):1378-82, 2010
Park YS et al: Posterior atlantoaxial screw-rod fixation in a case of aberrant vertebral artery course combined with bilateral high-riding vertebral artery. J Korean Neurosurg Soc. 48(4):367-70, 2010
Wang S et al: Pedicle versus laminar screws: what provides more suitable C2 fixation in congenital C2-3 fusion patients? Eur Spine J. 19(8):1306-11, 2010
Heuer GG et al: Treatment of pediatric atlantoaxial instability with traditional and modified Goel-Harms fusion constructs. Eur Spine J. 18(6):884-92, 2009
Ahmed R et al: Fusions at the craniovertebral junction. Childs Nerv Syst. 24(10):1209-24, 2008
Menendez JA et al: Techniques of posterior C1-C2 stabilization. Neurosurgery. 60(1 Supp1 1):S103-11, 2007
Hagino T et al: Fracture of the atlas through a synchondrosis of the anterior arch complicated by atlantoaxial rotatory fixation in a four-year-old child. J Bone Joint Surg Br. 88(8):1093-5, 2006
Mummaneni PV et al: Atlantoaxial fixation: overview of all techniques. Neurol India. 53(4):408-15, 2005
Rahimi SY et al: Treatment of atlantoaxial instability in pediatric patients. Neurosurg Focus. 15(6):ECP1, 2003
Madawi AA et al: Radiological and anatomical evaluation of the atlantoaxial transarticular screw fixation technique. J Neurosurg. 86(6):961-8, 1997
Coric D et al: Arteriovenous fistula as a complication of C1-2 transarticular screw fixation. Case report and review of the literature. J Neurosurg. 85(2):340-3, 1996
Grob D: Principles of surgical treatment of the cervical spine in rheumatoid arthritis. Eur Spine J. 2(4):180-90, 1993
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
TERMINOLOGY
Synonyms
Atlantoaxial fusion
Definitions
With sublaminar wires or clamp
Gallie fusion (1939)
Placement of bone graft between dorsal arch of C1 and spinous process of C2
Secured by sublaminar wires
Single midline point of fixation → poor stabilization with rotation
Halo required for postoperative immobilization
Brooks fusion (1979)
Bilateral interlaminar bone grafts, secured by bilateral sublaminar wires
Tightening wires will increase compression of grafts
More rotational stability than Gallie method
Locksley method uses 3-point fixation with bilateral autograft attached with sublaminar wires, tightened in "figure 8" pattern
Addition of midline plate attached by wires to posterior spinous processes
Halifax clamp (1975)
Claw-type construct allowing immediate fixation without risk of sublaminar wires
Bone graft placed in interlaminar spaces bilaterally
Requires intact arch of C1
Sublaminar wire in cervical spine associated with 7-17% risk of neurologic injury
Without sublaminar wires
Magerl transarticular screwfixation (1987)
Provides biomechanical stability, particularly against rotational motion and lateral bending
Immediate stabilization by C1-C2 transarticular lateral mass screws
↑ fusion rate (> 90%)
No need for postoperative immobilization
Decreased malalignment
Meticulous operative planning/navigation required to miss vertebral artery (VA) with screws
4-6% VA injury rate
20% of patients have anatomy that precludes transarticular placement
Screw and rod fixation (Harms, 2001)
Lateral mass screws at C1, with pedicle/pars screws at C2 secured by rods bilaterally
No structural grafting or wiring required
VA injury risk similar to that of transarticular screws
Can be performed in patients with body habitus/anatomy unfavorable to transarticular screw
C2 translaminar screws
↓ risk of VA injury
No challenges related to body habitus
↑ pseudoarthrosis rate
↓ rigidity of fixation
PRE-PROCEDURE
Indications
Contraindications
Pre-Procedure Imaging
OUTCOMES
Complications
Selected References
Denaro V et al: The best surgical treatment for type II fractures of the dens is still controversial. Clin Orthop Relat Res. 469(3):742-50, 2011
Bahadur R et al: Transarticular screw fixation for atlantoaxial instability - modified Magerl's technique in 38 patients. J Orthop Surg Res. 5:87, 2010
Conroy E et al: C1 lateral mass screw-induced occipital neuralgia: a report of two cases. Eur Spine J. 19(3):474-6, 2010
Lall R et al: A review of complications associated with craniocervical fusion surgery. Neurosurgery. 67(5):1396-402; discussion 1402-3, 2010
Ma W et al: Clinical application of C2 laminar screw technique. Eur Spine J. 19(8):1312-7, 2010
Ni B et al: Bilateral C1 laminar hooks combined with C2 pedicle screws fixation for treatment of C1-C2 instability not suitable for placement of transarticular screws. Eur Spine J. 19(8):1378-82, 2010
Park YS et al: Posterior atlantoaxial screw-rod fixation in a case of aberrant vertebral artery course combined with bilateral high-riding vertebral artery. J Korean Neurosurg Soc. 48(4):367-70, 2010
Wang S et al: Pedicle versus laminar screws: what provides more suitable C2 fixation in congenital C2-3 fusion patients? Eur Spine J. 19(8):1306-11, 2010
Heuer GG et al: Treatment of pediatric atlantoaxial instability with traditional and modified Goel-Harms fusion constructs. Eur Spine J. 18(6):884-92, 2009
Ahmed R et al: Fusions at the craniovertebral junction. Childs Nerv Syst. 24(10):1209-24, 2008
Menendez JA et al: Techniques of posterior C1-C2 stabilization. Neurosurgery. 60(1 Supp1 1):S103-11, 2007
Hagino T et al: Fracture of the atlas through a synchondrosis of the anterior arch complicated by atlantoaxial rotatory fixation in a four-year-old child. J Bone Joint Surg Br. 88(8):1093-5, 2006
Mummaneni PV et al: Atlantoaxial fixation: overview of all techniques. Neurol India. 53(4):408-15, 2005
Rahimi SY et al: Treatment of atlantoaxial instability in pediatric patients. Neurosurg Focus. 15(6):ECP1, 2003
Madawi AA et al: Radiological and anatomical evaluation of the atlantoaxial transarticular screw fixation technique. J Neurosurg. 86(6):961-8, 1997
Coric D et al: Arteriovenous fistula as a complication of C1-2 transarticular screw fixation. Case report and review of the literature. J Neurosurg. 85(2):340-3, 1996
Grob D: Principles of surgical treatment of the cervical spine in rheumatoid arthritis. Eur Spine J. 2(4):180-90, 1993
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