Abstract
Objective
To explore the effect of pedicle screw instrument in treatment of irreducible atlantoaxial dislocation.
Patients and method
From June 2003 to February 2009, 14 cases of atlas dislocation with upper cervical cord compression were enrolled and anterior transoral soft tissue release combined with posterior reduction and pedicle screw fixation were performed. CT, MRI and radiograph were used preoperatively, and screw placement and bone graft were administered in all cases intraoperatively. Cervical collars were used for 3 months.
Results
Screws were successfully placed in atlas in all cases. The average follow-up period was 18 months. Bone fusion was observed in all cases without the following complications: neurologic symptoms, internal fixation failure and redislocation. Neurological recovery was observed in all 14 cases.
Conclusions
Pedicle screw instrument has the following advantages in atlas and axis injury treatment: direct screw placement, short-segment fusion, intraoperative reduction and high fusion rate, which should be a better surgical method for the treatment of atlantoaxial dislocation.
References
Tan M, Wang H, Wang Y, Zhang G, Yi P, Li Z, Wei H, Yang F (2003) Morphometric evaluation of screw fixation in atlas via posterior arch and lateral mass. Spine (Phila Pa 1976) 28(9):888–895. doi:10.1097/01.BRS.0000058719.48596.CC
Guo X, Ni B, Xie N, Lu X, Guo Q, Lu M (2014) Bilateral C1–C2 transarticular screw and C1 laminar hook fixation and bone graft fusion for reducible atlantoaxial dislocation: a seven-year analysis of outcome. PLoS One 9(1):e87676. doi:10.1371/journal.pone.0087676
Chowdhury FH, Haque MR (2014) C1–C3 lateral mass screw-rod fixation and fusion for C2 pathologies and Hangman’s fractures. Asian Spine J 8(6):735–746. doi:10.4184/asj.2014.8.6.735
Kim HS, Suk KS, Moon SH, Lee HM, Kang KC, Lee SH, Kim JS (2015) Safety evaluation of freehand lateral mass screw fixation in the subaxial cervical spine: evaluation of 1256 screws. Spine (Phila Pa 1976) 40(1):2–5. doi:10.1097/BRS.0000000000000667
Dahdaleh NS, Dlouhy BJ, Menezes AH (2013) One-step fixation of atlantoaxial rotatory subluxation: technical note and report of three cases. World Neurosurg 80(6):e391–e395. doi:10.1016/j.wneu.2012.11.040
Ma X, Yin Q, Xia H, Wu Z, Yang J, Liu J, Xu J, Qiu F (2015) The application of atlantoaxial screw and rod fixation in revision operations for postoperative re-dislocation in children. Arch Orthop Trauma Surg. doi:10.1007/s00402-014-2150-1
Meng XZ, Xu JX (2011) The options of C2 fixation for os odontoideum: a radiographic study for the C2 pedicle and lamina anatomy. Eur Spine J 20(11):1921–1927. doi:10.1007/s00586-011-1893-4
He BR, Hao DJ, Zhou JS, Liu TJ, Wu Q, Guo H, Wang XD (2005) Treatment of atlantoaxial instability by using lateral mass screw of atlas combined with vertebra dentata pedic le screw. Chin J Trauma 21(10):4
Pissonnier ML, Lazennec JY, Renoux J, Rousseau MA (2013) Trauma of the upper cervical spine: focus on vertical atlantoaxial dislocation. Eur Spine J 22(10):2167–2175. doi:10.1007/s00586-013-2841-2
Wang J, Xia H, Ying Q, Lu Y, Wu Z, Ai F, Ma X (2013) An anatomic consideration of C2 vertebrae artery groove variation for individual screw implantation in axis. Eur Spine J 22(7):1547–1552. doi:10.1007/s00586-013-2779-4
Xu J, Yin Q, Xia H, Wu Z, Ma X, Zhang K, Wang Z, Yang J, Ai F, Wang J, Liu J, Mai X (2013) New clinical classification system for atlantoaxial dislocation. Orthopedics 36(1):e95–100. doi:10.3928/01477447-20121217-25
Resnick DK, Benzel EC (2002) C1–C2 pedicle screw fixation with rigid cantilever beam construct: case report and technical note. Neurosurgery 50(2):426–428
Ishikawa M, Cao K, Pang L, Watanabe K, Yagi M, Hosogane N, Machida M, Shiono Y, Nishiyama M, Fukui Y, Matsumoto M (2015) Postoperative behavior of thoracolumbar/lumbar curve and coronal balance after posterior thoracic fusion for Lenke 1C and 2C adolescent idiopathic scoliosis. J Orthop Sci 20(1):31–37. doi:10.1007/s00776-014-0655-7
Mandel IM, Kambach BJ, Petersilge CA, Johnstone B, Yoo JU (2000) Morphologic considerations of C2 isthmus dimensions for the placement of transarticular screws. Spine (Phila Pa 1976) 25(12):1542–1547
Ebraheim N, Rollins JR Jr, Xu R, Jackson WT (1996) Anatomic consideration of C2 pedicle screw placement. Spine (Phila Pa 1976) 21(6):691–695
Yin YH, Qiao GY, Yu XG, Tong HY, Zhang YZ (2013) Posterior realignment of irreducible atlantoaxial dislocation with C1–C2 screw and rod system: a technique of direct reduction and fixation. Spine J 13(12):1864–1871. doi:10.1016/j.spinee.2013.08.014
Ma XY, Zhong SZ, Liu JF, Yin QS, Xu DC, Peng CH (2003) Anatomic study of the atlas pedicle screw entry point. J Bone Jt Inj 18 (10):3. doi:10.3969/j.issn.1672-9935.2003.10.014
Huang DG, Hao DJ, Li GL, Guo H, Zhang YC, He BR (2014) C2 nerve dysfunction associated with C1 lateral mass screw fixation. Orthop Surg 6(4):269–273. doi:10.1111/os.12136
Acknowledgements
The work was supported by Shenzhen Bioactive Materials Engineering Lab for Medicine.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Rights and permissions
About this article
Cite this article
Zhai, My., Wang, Cp., Liu, F. et al. The efficacy of pedicle screw instrument in treatment of irreducible atlantoaxial dislocation. Arch Orthop Trauma Surg 135, 1193–1199 (2015). https://doi.org/10.1007/s00402-015-2261-3
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-015-2261-3