Artikel
The combination of transarticular- (Magerl technique) and C1 lateral mass- with C2 pedicle screw (Goel-Harms Technique) placement in atlanto-axial region seems to be a safe and feasible option in complex and limited cervical spine conditions
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Autoren
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Markus Schomacher
- Vivantes Klinikum Neukölln, Klinik für Neurochirurgie, Berlin, Deutschland
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Patrick Reid
- University of California San Francisco, Department of Neurosurgery, San Francisco, CA, Vereinigte Staaten
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Joseph Orsorio
- University of California San Francisco, Department of Neurosurgery, San Francisco, CA, Vereinigte Staaten
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Christopher P. Ames
- University of California San Francisco, Department of Neurosurgery, San Francisco, CA, Vereinigte Staaten
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: The atlanto-axial region is a complex area of anatomical structures. Stabilization procedures in this region present a unique set of challenges with complexity in screw placement, lack of fusion surface and avoidance of vertebral artery injury. If one of the well-established C1-C2 fusion techniques (Magerl- or Goel-Harms-technique) cannot be consistently performed, a combination of both might be a safe and feasible alternative.
Methods: We present the case of a 76 year-old woman with history of prior C4-C7 ACDF and posterior spinal fusion for cervical spondylotic myelopathy. Patient's complaints are worsening of hand numbness and -function with presence of neck- but no significant arm pain. On physical exam no gait disturbances were seen. Normal motor function was present at the extremities but diminished hand-sensations bilaterally. An MRI revealed a pseudotumor and stenosis as a result of microinstability of the C1-C2 complex. Indication for surgery was seen and performed as described:
The patient was positioned prone in the Mayfield head holder. A dorsal incision was made from C1 to C5. The spine was dissected and prior instrumentation was removed at the upper level at C4. The lamina at C3 and C2-pedicles were exposed. On right side the C1-lateral mass was carefully exposed and a C1-lateral mass screw and C2-pedicle screw were placed. Because on left side the intraoperative anatomy of articular surface of C1/2 was complex and limited a transarticular screw was placed after an intraoperative CT with navigation. The rods were reattached and a wide decompression of the laminar bone of C1 and C2 was performed. After decortication from C1 to C5 allograft bone mix with BMP was placed before wound closure.
Results: Post-surgery the patient was admitted to ICU for neurological monitoring. No new clinical neurological findings could be evaluated. Postoperative X-rays showed a good cervical alignment and intact spinal implants. The postoperative hospital course was unremarkable with regular wound healing. The patient was discharged at home with healthcare support.
Conclusion: The combination of two different C1-C2 posterior fusion techniques caused by anatomical or other reasons appears to be a feasible alternative surgical procedure. Such type of procedures should be considered in surgeon's surgical preparations. However to proof reliability of such alternative surgical techniques further studies with large numbers of patients should be conducted.
