Morphological and Clinical Feasibility of C3 Pedicle Screw Instrumentation in Patients with Congenital C2-3 Fusion

Overview

Journal Eur Spine J

Specialty Orthopedics

Date 2014 Jun 5

PMID 24894411

Citations 2

Authors

Peng Xiu

Qing Wang

Gaoju Wang

Song Wang

Guidong Dai

Yongshu Lan

Affiliations

Soon will be listed here.

Abstract

Purpose: Congenital C2-3 fusion (C2-3CF) is often involved in patients with atlantoaxial dislocation, and posterior occipitocervical fixation surgery is usually required. Hypoplasia of C2 pedicle is common in such patients, making C2 pedicle screws (PS) instrumentation inapplicable. Because of congenital fusion, C3PS instrumentation would be an ideal alternative for it will not sacrifice an additional motion segment; however, the morphological and clinical feasibility has not been previously reported.

Methods: We included 42 C2-3CF patients to this study and evaluated pedicle trajectories of C2 and C3 using a three-dimensional CT. Clinical applications of C3PS instrumentation were evaluated and followed.

Results: Among the 42 patients, 23 (54.8%) and 8 (19.0%) had C2 and C3 pedicle trajectory diameters <4.0 mm, respectively. The bisection line of the fused C2-3 lamina was used to represent the superior border of C3 articular mass; the entry point of C3 pedicle was located at 3 mm inferior to the assumed superior border and 3.2 mm medial to the lateral border. Bilateral C3PS instrumentations were successfully adopted in 22 patients. No spinal cord or vertebral artery injury occurred; postoperative CT showed a trajectory breach rate of 17.4% for C3PS. After mean of 3.6-year follow-up, no implant failure was documented.

Conclusions: C3PS instrumentation is morphologically and clinically feasible for a large proportion of patients with C2-3CF and can serve as another reliable alternative for C2PS instrumentation. Preoperative evaluation of pedicle trajectory of C2-3CF with three-dimensional CT is highly valuable in the choice of proper fixation methods.

Citing Articles

Application of C2 subfacetal screws for the management of atlantoaxial dislocation in patients with Klippel-Feil syndrome characterized by a narrow C2 pedicle and high-riding vertebral artery.

Hou Z, Jian Q, Fan W, Zhao X, Wang Y, Fan T J Orthop Surg Res. 2022; 17(1):495.

PMID: 36384627 PMC: 9670565. DOI: 10.1186/s13018-022-03391-z.

Can C1 lateral mass and C3 pedicle screw fixation be used as an option for atlantoaxial reduction and stabilization in Klippel-Feil patients? A study of its morphological feasibility, technical nuances, and clinical efficiency.

Du Y, Yin Y, Li T, Qiao G, Yu X Neurosurg Rev. 2022; 45(3):2183-2192.

PMID: 35022938 DOI: 10.1007/s10143-021-01729-5.

References

Miller R, Ebraheim N, Xu R, Yeasting R . Anatomic consideration of transpedicular screw placement in the cervical spine. An analysis of two approaches. Spine (Phila Pa 1976). 1996; 21(20):2317-22. DOI: 10.1097/00007632-199610150-00003. View

Yukawa Y, Kato F, Ito K, Horie Y, Hida T, Nakashima H . Placement and complications of cervical pedicle screws in 144 cervical trauma patients using pedicle axis view techniques by fluoroscope. Eur Spine J. 2009; 18(9):1293-9. PMC: 2899535. DOI: 10.1007/s00586-009-1032-7. View

Abumi K, Shono Y, Ito M, Taneichi H, Kotani Y, Kaneda K . Complications of pedicle screw fixation in reconstructive surgery of the cervical spine. Spine (Phila Pa 1976). 2000; 25(8):962-9. DOI: 10.1097/00007632-200004150-00011. View

Yonenobu K, Abumi K, Nagata K, Taketomi E, Ueyama K . Interobserver and intraobserver reliability of the japanese orthopaedic association scoring system for evaluation of cervical compression myelopathy. Spine (Phila Pa 1976). 2001; 26(17):1890-4; discussion 1895. DOI: 10.1097/00007632-200109010-00014. View

Jones E, Heller J, Silcox D, Hutton W . Cervical pedicle screws versus lateral mass screws. Anatomic feasibility and biomechanical comparison. Spine (Phila Pa 1976). 1997; 22(9):977-82. DOI: 10.1097/00007632-199705010-00009. View

Frankel H, Hancock D, Hyslop G, MELZAK J, MICHAELIS L, UNGAR G . The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I. Paraplegia. 1969; 7(3):179-92. DOI: 10.1038/sc.1969.30. View

Yamazaki M, Okawa A, Furuya T, Sakuma T, Takahashi H, Kato K . Anomalous vertebral arteries in the extra- and intraosseous regions of the craniovertebral junction visualized by 3-dimensional computed tomographic angiography: analysis of 100 consecutive surgical cases and review of the literature. Spine (Phila Pa 1976). 2012; 37(22):E1389-97. DOI: 10.1097/BRS.0b013e31826a0c9f. View

Yoshida M, Neo M, Fujibayashi S, Nakamura T . Comparison of the anatomical risk for vertebral artery injury associated with the C2-pedicle screw and atlantoaxial transarticular screw. Spine (Phila Pa 1976). 2006; 31(15):E513-7. DOI: 10.1097/01.brs.0000224516.29747.52. View

Xu R, Nadaud M, Ebraheim N, Yeasting R . Morphology of the second cervical vertebra and the posterior projection of the C2 pedicle axis. Spine (Phila Pa 1976). 1995; 20(3):259-63. DOI: 10.1097/00007632-199502000-00001. View

10.

Panjabi M, Shin E, Chen N, Wang J . Internal morphology of human cervical pedicles. Spine (Phila Pa 1976). 2000; 25(10):1197-205. DOI: 10.1097/00007632-200005150-00002. View

11.

Yoshimoto H, Sato S, Hyakumachi T, Yanagibashi Y, Masuda T . Spinal reconstruction using a cervical pedicle screw system. Clin Orthop Relat Res. 2005; (431):111-9. DOI: 10.1097/01.blo.0000150321.81088.ab. View

12.

Ito H, Neo M, Yoshida M, Fujibayashi S, Yoshitomi H, Nakamura T . Efficacy of computer-assisted pedicle screw insertion for cervical instability in RA patients. Rheumatol Int. 2006; 27(6):567-74. DOI: 10.1007/s00296-006-0256-7. View

13.

Smith Z, Bistazzoni S, Onibokun A, Chen N, Sassi M, Khoo L . Anatomical considerations for subaxial (C2) pedicle screw placement: a radiographic study with computed tomography in 93 patients. J Spinal Disord Tech. 2010; 23(3):176-9. DOI: 10.1097/BSD.0b013e3181b40234. View

14.

Bransford R, Russo A, Freeborn M, Nguyen Q, Lee M, Chapman J . Posterior C2 instrumentation: accuracy and complications associated with four techniques. Spine (Phila Pa 1976). 2011; 36(14):E936-43. DOI: 10.1097/BRS.0b013e3181fdaf06. View

15.

Shen F, Samartzis D, Herman J, Lubicky J . Radiographic assessment of segmental motion at the atlantoaxial junction in the Klippel-Feil patient. Spine (Phila Pa 1976). 2006; 31(2):171-7. DOI: 10.1097/01.brs.0000195347.35380.68. View

16.

Tokuda K, Miyasaka K, Abe H, Abe S, Takei H, Sugimoto S . Anomalous atlantoaxial portions of vertebral and posterior inferior cerebellar arteries. Neuroradiology. 1985; 27(5):410-3. DOI: 10.1007/BF00327604. View

17.

Anderson L, DAlonzo R . Fractures of the odontoid process of the axis. J Bone Joint Surg Am. 1974; 56(8):1663-74. View

18.

Abumi K, Takada T, Shono Y, Kaneda K, Fujiya M . Posterior occipitocervical reconstruction using cervical pedicle screws and plate-rod systems. Spine (Phila Pa 1976). 1999; 24(14):1425-34. DOI: 10.1097/00007632-199907150-00007. View

19.

Resnick D, Lapsiwala S, Trost G . Anatomic suitability of the C1-C2 complex for pedicle screw fixation. Spine (Phila Pa 1976). 2002; 27(14):1494-8. DOI: 10.1097/00007632-200207150-00003. View

20.

Wang S, Wang C, Leng H, Zhao W, Yan M, Zhou H . Cable-strengthened C2 pedicle screw fixation in the treatment of congenital C2-3 fusion, atlas occipitalization, and atlantoaxial dislocation. Neurosurgery. 2012; 71(5):976-84. DOI: 10.1227/NEU.0b013e31826cdd3b. View