Abstract
The occipitocervical junction is a complex transitional zone between the cranium and the upper spine. It composes two major joints: the atlantooccipital joint, which allows half of the overall flexion-extension motion of the cervical spine and the atlantoaxial joint, which is responsible for the majority of cervical rotation. Bilateral banding, distraction and axial loading are other important features of this region [1, 2]. Degenerative, inflammatory and tumorous lesions can cause instability of these two joints, which may require instrumentation and fusion. Since the majority of cases involve atlantoaxial instability, this chapter focusses on C1/C2 fixation, while the following chapter on basilar invagination also discusses occipitocervical instrumentation in detail.
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References and Level of Evidence (EBM)
White AA, Panjabi MM. The clinical biomechanics of the occipitoatlantoaxial complex. Orthop Clin North Am. 1978;9:867–78. EBM IV
Offiah CE, Day E. The craniocervical junction: embryology, anatomy, biomechanics and imaging in blunt trauma. Insights Imaging. 2017;8:29–47. EBM V
Harms J, Melcher RP. Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976). 2001;26:2467–71. EBM IV
Jeanneret B, Magerl F. Primary posterior fusion C1/2 in odontoid fractures: indications, technique, and results of transarticular screw fixation. J Spinal Disord. 1992;5:464–75. EBM IV
Yamazaki M, Okawa A, Furuya T, et al. 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:E1389–97. EBM IV
Gluf WM, Brockmeyer DL. Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications, and lessons learned in 67 pediatric patients. J Neurosurg Spine. 2005;2:164–9. EBM IV
Huang DG, Hao DJ, He BR, et al. Posterior atlantoaxial fixation: a review of all techniques. Spine J. 2015;15:2271–81. EBM V
Sim HB, Lee JW, Park JT, Mindea SA, Lim J, Park J. Biomechanical evaluations of various c1-c2 posterior fixation techniques. Spine (Phila Pa 1976). 2011;36:E401–7. EBM V
Pitzen T, Salman E, Ostrowski G, Welk T, Ruf M, Drumm J. Left-right axial rotation within C1-2 after implant removal. J Neurosurg Spine. 2013;19:688–93. EBM IV
Hitti FL, Hudgins ED, Chen HI, Malhotra NR, Zager EL, Schuster JM. Intraoperative navigation is associated with reduced blood loss during C1-C2 posterior cervical fixation. World Neurosurg. 2017;107:574–8. EBM IV
Czabanka M, Haemmerli J, Hecht N, et al. Spinal navigation for posterior instrumentation of C1-2 instability using a mobile intraoperative CT scanner. J Neurosurg Spine. 2017;27:268–75. EBM IV
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Tschugg, A., Hartmann, S., Thomé, C. (2019). C0/C1/C2 Instrumentation Techniques. In: Meyer, B., Rauschmann, M. (eds) Spine Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-98875-7_50
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DOI: https://doi.org/10.1007/978-3-319-98875-7_50
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