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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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The anterior transarticular fixation of C1/C2 in the elderly: a feasibility study with respect to "safe entry" zones of the articular process of C2

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  • Rebecca Leyrer - Universitätsklinikum Essen der Universität Duisburg-Essen, Klinik und Poliklinik für Neurochirurgie, Essen, Deutschland
  • Nicolai El Hindy - Universitätsklinikum Essen der Universität Duisburg-Essen, Klinik und Poliklinik für Neurochirurgie, Essen, Deutschland
  • Christoph Mönninghoff - Institut für Neuroradiologie, Essen, Deutschland
  • Oliver Gembruch - Universitätsklinikum Essen der Universität Duisburg-Essen, Klinik und Poliklinik für Neurochirurgie, Essen, Deutschland
  • Karsten H. Wrede - Universitätsklinikum Essen der Universität Duisburg-Essen, Klinik und Poliklinik für Neurochirurgie, Essen, Deutschland
  • Ulrich Sure - Universitätsklinikum Essen der Universität Duisburg-Essen, Klinik und Poliklinik für Neurochirurgie, Essen, Deutschland
  • Oliver M. Müller - Universitätsklinikum Essen der Universität Duisburg-Essen, Klinik und Poliklinik für Neurochirurgie, Essen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.08.04

doi: 10.3205/17dgnc226, urn:nbn:de:0183-17dgnc2267

Published: June 9, 2017

© 2017 Leyrer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: To evaluate the feasibility of an anterior C1/C2 fixation in elderly patients with instable atlanto-axial fractures.

Methods: Between January 2015 and October 2016 a consecutive cohort of 10 patients were operated with transarticular fixation of C1/C2 from anteriorly. All patients were operated using cannulated small-fragment screws (DePuy Synthes; 22-26mm, 3.4-4.5mm) that were laterally of the corpus of C2 passed through the joints. If necessary, an additional screw was placed in the odontoid process. Placement was radiographically checked using the 3D Arcadis Orbic (Siemens, Erlangen, GER). The course of the vertebral artery was analyzed in a CT morphometric study.

Results: In all patients (6 female, 4 men; mean age 80 years), the screws could be placed finally. Two screws had to be corrected intraoperatively for initial mal-placement. No neurological deficit occurred, neither was an injury of the vertebral artery observed. Yet, all patients suffered from swallowing difficulties in the postoperative course without any injury to the neck organs occurring. In two patients, an additional posterior fixation had to be carried after six and 9 months due to loosening of the screws. Operation time was significantly shorter for the anterior approach compared to dorsal stabilization. Intraoperative X-ray doses were comparatively higher with the anterior approach, which is explained by the intraoperative 3D scan that is otherwise skipped in the posterior procedures. The mean “safety zone” for the screw entry comprised 9.5mm*9.5mm (range 7.5-11.5mm).

Conclusion: The anterior approach for fixation of C1/C2 can be a valuable option in the treatment of instable C1/C2 fractures especially in the elderly. Yet, the biomechanical properties of the anterior approach are inferior to a dorsal fixation. The operation time in our collective was significantly shorter.