Senturk Salim, Akyoldas Goktug, Yaman Onur, Ozer Ali Fahir
Koc University Hospital, Department of Neurosurgery, Istanbul, Turkey.
Turk Neurosurg. 2017 Mar 9. doi: 10.5137/1019-5149.JTN.20022-17.1.
Atlantoaxial instability is a special entity that may be caused by many disorders such as trauma, tumor, arthritis, congenital malformation and infection. Atlantoaxial fixation is needed to provide stability, prevent neurological deficits and correct deformity. The objective of this study is to introduce an alternative technique for the treatment of atlantoaxial instability in patients who have vertebral artery anomaly, anomalous C2 or osteoporosis.
C1-2-3 fixation was performed in a 50-years-old, male patient with atlantoaxial instability due to os odontoideum. C1 lateral masses identified and screw placement was performed. C2 facet joints were identified bilaterally. Superior margin of junction of pedicle and the lamina was used as the entry point and 3.5x22 mm screws were inserted from C2 facet joint to the C3 facet joint in mediolateral and craniocaudal direction under fluoroscopic guidance with caution. The posterior fixation screws are interconnected with two rods. Finally, autologous grafts were placed posterolaterally to encourage the fusion.
Patient's complaints relieved after the surgery. C1-C2 instability wasn't seen in the postoperative radiological examinations.
In the surgical treatment of C1-2 instability, our technique could help to reduce the possibility of vertebral artery injury in patients who have a vertebral artery course anomaly or when it is difficult to place C2 pedicle screws due to anomalous C2 pedicles and osteoporosis. High fusion rate could be achived with this technique due to passing through the four cortical surfaces. No wire or allograft was required. Thus, the instrumentation cost could be reduced.
寰枢椎不稳是一种特殊情况，可由多种疾病引起，如创伤、肿瘤、关节炎、先天性畸形和感染。需要进行寰枢椎固定以提供稳定性、预防神经功能缺损并纠正畸形。本研究的目的是介绍一种替代技术，用于治疗患有椎动脉异常、C2异常或骨质疏松症的寰枢椎不稳患者。
对一名50岁男性齿突骨导致寰枢椎不稳的患者进行C1-2-3固定。识别C1侧块并进行螺钉置入。双侧识别C2关节突关节。以椎弓根与椎板交界处的上缘作为进针点，在透视引导下小心地从C2关节突关节向C3关节突关节在中外侧和头尾方向插入3.5×22mm螺钉。后固定螺钉用两根棒连接。最后，在外侧后方放置自体移植物以促进融合。
术后患者的症状缓解。术后影像学检查未发现C1-C2不稳。
在C1-2不稳的手术治疗中，我们的技术有助于降低患有椎动脉走行异常或因C2椎弓根异常和骨质疏松症而难以置入C2椎弓根螺钉的患者发生椎动脉损伤的可能性。由于该技术穿过四个皮质表面，可实现高融合率。无需钢丝或同种异体移植物。因此，可降低器械成本。
