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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
- Gallie fusion (1939)
- 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
- Magerl transarticular screwfixation (1987)
- With sublaminar wires or clamp
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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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
- Gallie fusion (1939)
- 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
- Magerl transarticular screwfixation (1987)
- With sublaminar wires or clamp
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
