Song G S, Theodore N, Dickman C A, Sonntag V K
Division of Neurological Surgery, Barrow Neurological Institute, Mercy Healthcare Arizona, Phoenix 85013, USA.
J Neurosurg. 1997 Dec;87(6):851-5. doi: 10.3171/jns.1997.87.6.0851.
Bilateral posterior C 1-2 transfacet screw placement with associated posterior bone graft wiring is the accepted treatment for patients with atlantoaxial instability. This technique was modified to treat 19 patients with atlantoaxial instability and unilateral anomalies that prevented placement of a screw across the C1-2 facet. In these cases, a single contralateral transarticular screw was placed in conjunction with interspinous bone graft wiring to avoid neural or vertebral artery injury and to provide C1-2 stability. Postoperatively, all 19 patients were placed in Philadelphia collars (mean immobilization 8 weeks, range 6-12 weeks). Unilateral C1-2 facet screw fixation was needed for the following reasons: a high-riding transverse foramen of the C-2 vertebra present in 13 patients (left side in eight, right side in five), poor screw purchase in two (left side in both), screw malposition in one (left side), severe degenerative arthritis in one (right side), neurofibroma in one (right side), and fracture of the C-1 lateral mass in one (left side). Six weeks postsurgery, one patient presented with a broken screw and required occipitocervical fusion with a Steinmann pin and wire cable from the occiput to C-3 to achieve solid fusion. Solid fusions were achieved in the other 18 patients (mean follow-up period 31 months, range 14-54 months); there was no delayed screw breakage, wire breakage, or spinal instability. There were no operative or postoperative neurological or vascular complications. The authors' experience demonstrates that unilateral C1-2 facet screw fixation with interspinous bone graft wiring is an excellent alternative in the treatment of atlantoaxial instability when bilateral screw fixation is contraindicated.
双侧C1-2经关节突螺钉置入联合后路植骨钢丝固定术是治疗寰枢椎不稳患者的公认方法。该技术经过改良，用于治疗19例寰枢椎不稳且存在单侧异常导致无法在C1-2关节突置入螺钉的患者。在这些病例中，采用单枚对侧经关节突螺钉联合棘突间植骨钢丝固定，以避免神经或椎动脉损伤并提供C1-2稳定性。术后，所有19例患者均佩戴费城颈托（平均固定8周，范围6-12周）。需要进行单侧C1-2关节突螺钉固定的原因如下：13例患者存在C2椎横突孔高位（8例在左侧，5例在右侧），2例（均在左侧）螺钉把持力差，1例（左侧）螺钉位置不当，1例（右侧）严重退行性关节炎，1例（右侧）神经纤维瘤，1例（左侧）C1侧块骨折。术后6周，1例患者出现螺钉断裂，需要采用斯氏针和钢丝缆线进行枕颈融合术，从枕骨至C3以实现牢固融合。其他18例患者实现了牢固融合（平均随访期31个月，范围14-54个月）；未出现螺钉延迟断裂、钢丝断裂或脊柱不稳。无手术或术后神经或血管并发症。作者的经验表明，当双侧螺钉固定禁忌时，单侧C1-2关节突螺钉固定联合棘突间植骨钢丝固定是治疗寰枢椎不稳的一种极佳替代方法。
