Department of Surgery, Maimonides Medical Center, Brooklyn, New York, USA; Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA.
Department of Neurological Surgery, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA.
World Neurosurg. 2021 Apr;148:38-43. doi: 10.1016/j.wneu.2020.12.159. Epub 2021 Jan 7.
Occipitocervical fusion is an important surgical procedure to treat instability of the upper cervical and craniocervical junction. Fixation to the dense cortical bone of the occiput, contemporaneously typically accomplished with a plate and screws, is known to be strong and durable, but there are many competing methods used to secure an adequate number of fixation points of sufficient strength at the cervical end. Extension of hardware to the midcervical region to acquire additional fixation points, however, results in loss of subaxial motion segments and additional potential morbidity. The C2 vertebra is unique in that its morphology and dimensions permit fixation with longer screws than are typically possible to place in the midcervical lateral masses. Translaminar and pars screw techniques, both commonly used to achieve C2 fixation, are not mutually exclusive, as their respective trajectories are considerably different and engage different portions of the bony anatomy.
We describe a novel, 4-point C2 fixation technique for OC fusion that may avoid the need to extend fusion to the subaxial spine.
This technical note illustrates how 4-point C2 fixation can be employed in occiptocervical fusion.
4-point fixation of C2 combining translaminar and pars screw placement is technically feasible and may be a suitable strategy to spare subaxial motion segments in OC fusion procedures. Futher investigation may establish its applicability to additional surgical procedures.
枕颈融合术是治疗上颈椎和颅颈交界区不稳定的重要手术。通常使用板和螺钉将其固定在枕骨致密的皮质骨上，这种固定方式牢固且持久，但在颈椎端获得足够数量的固定点以确保足够强度时，有许多竞争的方法。然而，将硬件延伸到中颈椎区域以获得更多的固定点会导致下颈椎运动节段的丧失和更多的潜在发病率。C2 椎骨是独特的，其形态和尺寸允许使用比通常可放置在中颈椎侧块中的更长的螺钉进行固定。虽然常用于实现 C2 固定的经关节突和椎弓根螺钉技术并不相互排斥，但其各自的轨迹有很大的不同，并且与不同的骨解剖部分结合。
我们描述了一种用于 OC 融合的新型四点 C2 固定技术，该技术可能避免将融合延伸至下颈椎。
本技术说明展示了如何在枕颈融合术中使用四点 C2 固定。
四点 C2 固定结合经关节突和椎弓根螺钉的放置在技术上是可行的，并且可能是在 OC 融合手术中保留下颈椎运动节段的合适策略。进一步的研究可能会确定其在其他手术中的适用性。
