Short-term effectiveness of axis laminar screws for reducible atlantoaxial dislocation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 DENG Xuangeng , XIONG Xiaoming , SHI Huagang , WAN Dun , CUI Wei , SONG Simao , MEI Guolong , HOU Wei

Department of Spine, Sichuan Provincial Orthopedic Hospital, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

DENG Xuangeng, Email: tigerd@163.com

Keywords：

Reducible atlantoaxial dislocation; laminar screw; pedicle screw; internal fixation

DOI：

10.7507/1002-1892.201902026

Video：

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Objective To investigate reliability and short-term effectiveness of axis laminar screws for reducible atlantoaxial dislocation (RAAD).Methods A clinical data of 41 patients with RAAD who were admitted between February 2013 and February 2018 and met the inclusion criteria was retrospectively analyzed. The atlases in all patients were fixated by lateral mass screws, and the axes were fixed by laminar screws in 13 cases (LS group) and by pedicle screws in 28 cases (PS group). There was no significant difference in gender, age, and preoperative Japanese Orthopedic Association (JOA) score between the two groups (P>0.05). The effectiveness was estimated by post-operative JOA score; and the accuracy of the axis screw, atlantoaxial bone graft fusion, and the fixation stability were examined by X-ray film and CT.Results All incisions healed by first intention. All patients were followed up 12-17 months (mean, 13.8 months) in LS group and 12-20 months (mean 14.1 months) in PS group, and the difference in follow-up time was not significant (Z=−0.704, P=0.482). At last follow-up, JOA scores were 13.9±1.6 in LS group and 14.3±1.8 in PS group, which significantly improved when compared with the pre-operative scores in the two groups (t=−9.033, P=0.000; t=−15.835, P=0.000); while no significant difference was found between the two groups (t=−0.630, P=0.532). Twenty-five screws of 26 screws in LS group and 54 screws of 56 screws in PS group were implanted accurately, with no significant difference in the accuracy of the axis screw between the two groups (Z=−0.061, P=0.951). All patients obtained atlantoaxial bone graft fusion, except 1 case in PS group. There was no significant difference in the atlantoaxial bone graft fusion between the two groups (Z=−0.681, P=0.496).Conclusion For RAAD, Axis laminar screws can maintain the atlantoaxial primary stability and had a good short-term effectiveness. So, it could be an alternative and reliable technique for axis screw.

Citation： DENG Xuangeng, XIONG Xiaoming, SHI Huagang, WAN Dun, CUI Wei, SONG Simao, MEI Guolong, HOU Wei. Short-term effectiveness of axis laminar screws for reducible atlantoaxial dislocation. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(11): 1419-1423. doi: 10.7507/1002-1892.201902026 Copy

1.	Ma F, Kang M, Liao YH, et al. The use of intraoperative traction for achieving reduction of irreducible atlantoaxial dislocation caused by different craniovertebral junction pathologies. Clin Neurol Neurosurg, 2018, 175: 98-105.
2.	Wright NM. Posterior C2 fixation using bilateral, crossing C2 laminar screws: case series and technical note. J Spinal Disord Tech, 2004, 17(2): 158-162.
3.	Sai Kiran NA, Sivaraju L, Vidyasagar K, et al. Safety and accuracy of anatomic and lateral fluoroscopic-guided placement of C2 pars/pedicle screws and C1 lateral mass screws, and freehand placement of C2 laminar screws. World Neurosurg, 2018, 118: e304-e315.
4.	Wang Y, Wang C, Yan M. Clinical outcomes of atlantoaxial dislocation combined with high-riding vertebral artery using C2 translaminar screws. World Neurosurg, 2019, 122: e1511-e1518.
5.	Dmitriev AE, Lehman RA Jr, Helgeson MD, et al. Acute and long-term stability of atlantoaxial fixation methods: a biomechanical comparison of pars, pedicle, and intralaminar fixation in an intact and odontoid fracture model. Spine, 2009, 34(4): 365-370.
6.	Dou N, Lehrman JN, Newcomb AGUS, et al. A novel C2 screw trajectory: preliminary anatomic feasibility and biomechanical comparison. World Neurosurg, 2018, 113: e93-e100.
7.	Wang S, Tian Y, Diebo BG, et al. Treatment of atlantoaxial dislocations among patients with cervical osseous or vascular abnormalities utilizing hybrid techniques. J Neurosurg Spine, 2018, 29(2): 135-143.
8.	Kueny RA, Kolb JP, Lehmann W, et al. Influence of the screw augmentation technique and a diameter increase on pedicle screw fixation in the osteoporotic spine: pullout versus fatigue testing. Eur Spine J, 2014, 23(10): 2196-2202.
9.	Yang BW, Glotzbecker MP, Troy M, et al. C2 translaminar screw fixation in children. J Pediatr Orthop, 2018, 38(6): e312-e317.
10.	Kothari MK, Dalvie SS, Gupta S, et al. The C2 pedicle width, pars length, and laminar thickness in concurrent ipsilateral ponticulus posticus and high-riding vertebral artery: a radiological computed tomography scan-based study. Asian Spine J, 2019, 13(2): 290-295.
11.	Hu Y, He XF, Gu YJ, et al. Feasibility study on posterior laminar screw fixation techniques in the axis. Chin J Traumatol, 2010, 13(2): 77-82.
12.	Engler JA, Smith ML. Use of intraoperative fluoroscopy for the safe placement of C2 laminar screws: technical note. Eur Spine J, 2015, 24(12): 2771-2775.
13.	Elliott RE, Tanweer O, Boah A, et al. Comparison of safety and stability of C-2 pars and pedicle screws for atlantoaxial fusion: meta-analysis and review of literature. A systematic review. J Neurosurg Spine, 2012, 17(6): 577-593.
14.	吴超, 邓佳燕, 谭伦, 等. 逐渐扩大型 3D 打印导板系统辅助寰枢椎椎弓根植钉准确性分析及临床应用. 中国修复重建外科杂志, 2019, 33(2): 212-218.
15.	Clifton W, Nottmeier E, Edwards S, et al. Development of a novel 3D printed phantom for teaching neurosurgical trainees the freehand technique of C2 laminar screw placement. World Neurosurg, 2019, 129: e812-e820.
16.	Ji W, Liu X, Huang W, et al. Feasibility of C2 vertebra screws placement in patient with occipitalization of atlas: a tomographic study. Medicine (Baltimore), 2015, 94(37): e1492.
17.	Formentin C, Andrade EJ, Maeda FL, et al. Axis screws: results and complications of a large case series. Rev Assoc Med Bras (1992), 2019, 65(2): 198-203.

1. Ma F, Kang M, Liao YH, et al. The use of intraoperative traction for achieving reduction of irreducible atlantoaxial dislocation caused by different craniovertebral junction pathologies. Clin Neurol Neurosurg, 2018, 175: 98-105.
2. Wright NM. Posterior C2 fixation using bilateral, crossing C2 laminar screws: case series and technical note. J Spinal Disord Tech, 2004, 17(2): 158-162.
3. Sai Kiran NA, Sivaraju L, Vidyasagar K, et al. Safety and accuracy of anatomic and lateral fluoroscopic-guided placement of C2 pars/pedicle screws and C1 lateral mass screws, and freehand placement of C2 laminar screws. World Neurosurg, 2018, 118: e304-e315.
4. Wang Y, Wang C, Yan M. Clinical outcomes of atlantoaxial dislocation combined with high-riding vertebral artery using C2 translaminar screws. World Neurosurg, 2019, 122: e1511-e1518.
5. Dmitriev AE, Lehman RA Jr, Helgeson MD, et al. Acute and long-term stability of atlantoaxial fixation methods: a biomechanical comparison of pars, pedicle, and intralaminar fixation in an intact and odontoid fracture model. Spine, 2009, 34(4): 365-370.
6. Dou N, Lehrman JN, Newcomb AGUS, et al. A novel C2 screw trajectory: preliminary anatomic feasibility and biomechanical comparison. World Neurosurg, 2018, 113: e93-e100.
7. Wang S, Tian Y, Diebo BG, et al. Treatment of atlantoaxial dislocations among patients with cervical osseous or vascular abnormalities utilizing hybrid techniques. J Neurosurg Spine, 2018, 29(2): 135-143.
8. Kueny RA, Kolb JP, Lehmann W, et al. Influence of the screw augmentation technique and a diameter increase on pedicle screw fixation in the osteoporotic spine: pullout versus fatigue testing. Eur Spine J, 2014, 23(10): 2196-2202.
9. Yang BW, Glotzbecker MP, Troy M, et al. C2 translaminar screw fixation in children. J Pediatr Orthop, 2018, 38(6): e312-e317.
10. Kothari MK, Dalvie SS, Gupta S, et al. The C2 pedicle width, pars length, and laminar thickness in concurrent ipsilateral ponticulus posticus and high-riding vertebral artery: a radiological computed tomography scan-based study. Asian Spine J, 2019, 13(2): 290-295.
11. Hu Y, He XF, Gu YJ, et al. Feasibility study on posterior laminar screw fixation techniques in the axis. Chin J Traumatol, 2010, 13(2): 77-82.
12. Engler JA, Smith ML. Use of intraoperative fluoroscopy for the safe placement of C2 laminar screws: technical note. Eur Spine J, 2015, 24(12): 2771-2775.
13. Elliott RE, Tanweer O, Boah A, et al. Comparison of safety and stability of C-2 pars and pedicle screws for atlantoaxial fusion: meta-analysis and review of literature. A systematic review. J Neurosurg Spine, 2012, 17(6): 577-593.
14. 吴超, 邓佳燕, 谭伦, 等. 逐渐扩大型 3D 打印导板系统辅助寰枢椎椎弓根植钉准确性分析及临床应用. 中国修复重建外科杂志, 2019, 33(2): 212-218.
15. Clifton W, Nottmeier E, Edwards S, et al. Development of a novel 3D printed phantom for teaching neurosurgical trainees the freehand technique of C2 laminar screw placement. World Neurosurg, 2019, 129: e812-e820.
16. Ji W, Liu X, Huang W, et al. Feasibility of C2 vertebra screws placement in patient with occipitalization of atlas: a tomographic study. Medicine (Baltimore), 2015, 94(37): e1492.
17. Formentin C, Andrade EJ, Maeda FL, et al. Axis screws: results and complications of a large case series. Rev Assoc Med Bras (1992), 2019, 65(2): 198-203.

Chinese Journal of Reparative and Reconstructive Surgery

Short-term effectiveness of axis laminar screws for reducible atlantoaxial dislocation

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