Nazemi Alireza K, Bickley Stetson R, Behrend Caleb J, Carmouche Jonathan J
Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
Carilion Clinic Radiology, Roanoke, VA, USA.
Geriatr Orthop Surg Rehabil. 2017 Dec;8(4):263-267. doi: 10.1177/2151458517733158. Epub 2017 Oct 25.
In posterior spinal fusion (PSF), the vertebral artery is most vulnerable to injury at C1-2. C2 pedicle screws are often placed into the dorsomedial isthmus of C2. Alternative techniques include C2 laminar screws and wiring techniques. A 67-year-old male underwent PSF for persistent severe intractable neck pain and degeneration at C1-2. The patient had an enlarged left vertebral artery with midline migration into the C2 body. This pattern was within one standard deviation of normal; however, it rendered typical placement of a C2 pedicle screw unsafe. As a salvage, a C2 laminar screw was placed on the left to avoid risk of vertebral artery injury. The operation and recovery were without complication. C2 laminar screws can be viable alternatives to C2 pedicle screws in cases of midline vertebral artery migration or other vascular anomalies preventing normal safe placement of C2 pedicle screws.
在后路脊柱融合术（PSF）中，椎动脉在C1-2水平最易受伤。C2椎弓根螺钉常植入C2的背内侧峡部。替代技术包括C2椎板螺钉和钢丝技术。一名67岁男性因持续性严重顽固性颈部疼痛和C1-2退变接受了PSF手术。该患者左侧椎动脉增粗并向中线移位至C2椎体。这种情况在正常范围的一个标准差内；然而，这使得C2椎弓根螺钉的典型置入不安全。作为补救措施，在左侧置入了一枚C2椎板螺钉以避免椎动脉损伤风险。手术及恢复过程均无并发症。在椎动脉中线移位或存在其他血管异常而妨碍C2椎弓根螺钉正常安全置入的情况下，C2椎板螺钉可成为C2椎弓根螺钉的可行替代方案。
