Adida Samuel, Sefcik Roberta K, de-Thomas Ricardo J Fernández, Sen Ananya, Andrews Edward G, Agarwal Nitin, Gardner Paul A, Hamilton D Kojo
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA.
J Craniovertebr Junction Spine. 2025 Apr-Jun;16(2):254-256. doi: 10.4103/jcvjs.jcvjs_87_25. Epub 2025 Jul 3.
Instability of the occipitocervical junction may compress neural elements, resulting in progressive disability. After the technique was developed to correct for thoracolumbar scoliosis, the construct was developed for chin-on-chest deformity at the cervicothoracic junction as a similar three-rod approach. Demonstrated is a four-rod iteration utilized to stabilize the occipitocervical junction and correct condylar instability, termed the technique. A 34-year-old woman with Goldenhar syndrome, hemihypertrophy, and a complex neurosurgical history including Chiari decompression, clival chordoma resection, and a previous cervical fusion presented with quadriparesis, dysphagia, and bilateral upper extremity paresthesias. She was found to have pontomedullary and craniocervical instability with occipital translation and subluxation of the atlantooccipital joint, contributing to her neurological decline. A single midline incision and periosteal dissection exposed her prior O to C6 instrumented fusion. Existing rods were replaced, and a third plate-rod was placed on the right from O to C6. On the left, a fourth plate rod was positioned from C1 to C6. Four top-loading connectors secured the accessory rods to the primary construct. After confirming a stable lordotic alignment, distraction across the accessory rods was used to assist with coronal correction. The construct improved this patient's sagittal and coronal plane deformity. Postoperatively, the cervical sagittal vertical axis improved by 25 mm and the chin-brow angle by 20 mm. Significant improvements in functional status were achieved at 2-year follow-up. A one-stage posterior approach with construct augmentation using third and fourth accessory rods can correct atlantooccipital subluxation following failed occipitocervical fusion.
枕颈交界区不稳可能会压迫神经结构，导致进行性残疾。在用于矫正胸腰椎脊柱侧弯的技术得到发展之后，针对颈胸交界区的下巴贴胸畸形开发了一种类似的三棒技术。这里展示的是一种用于稳定枕颈交界区并矫正髁突不稳的四棒技术。一名34岁患有Goldenhar综合征、半身肥大且有复杂神经外科病史（包括Chiari减压术、斜坡脊索瘤切除术及既往颈椎融合术）的女性，出现了四肢瘫、吞咽困难及双侧上肢感觉异常。发现她存在脑桥延髓和颅颈不稳，伴有枕骨移位及寰枕关节半脱位，这导致了她的神经功能衰退。一个单一的中线切口及骨膜剥离暴露了她之前从枕骨到C6的器械辅助融合术。替换了现有的棒，并在右侧从枕骨到C6放置了第三根板棒。在左侧，从C1到C6放置了第四根板棒。四个顶装连接器将辅助棒固定到主要结构上。在确认获得稳定的前凸对线后，通过辅助棒进行撑开以协助冠状面矫正。这种技术改善了该患者矢状面和冠状面的畸形。术后，颈椎矢状垂直轴改善了25毫米，下巴-眉毛角改善了20毫米。在2年随访时功能状态有显著改善。采用第三根和第四根辅助棒进行结构增强的一期后路手术方法可在枕颈融合失败后矫正寰枕半脱位。
