Safety of atlantoaxial fusion using laminar and transarticular screws combined with an atlas hook in a patient with unilateral vertebral artery occlusion (case report)

Yoshihisa Sugimoto, Masato Tanaka, Kazuo Nakanishi, Haruo Misawa, Tomoyuki Takigawa, Yasuo Ito, Toshihumi Ozaki

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objective and importance: A disadvantage of transarticular and C2 pedicle screws is vertebral artery (VA) injury as a result of screw misplacement. If unilateral occlusion of the VA is present, VA injury of the dominant side will cause fatal complications as a result of collateral flow insufficiency. Several authors have recently reported the usefulness of C2 laminar screws because of their safety on VA injury. We used transarticular and C2 laminar screws combined with the atlas hook in a patient with C1-2 instability and unilateral VA occlusion, in order to reduce the risk of further VA injury. Clinical presentation: A 64-year-old woman with rheumatoid atlantoaxial subluxation complained of cervical myelopathy and neck pain. Preoperative MR angiography showed a left side VA occlusion. Technique: The patient underwent atlantoaxial, posterior fusion using a transarticular screw on the side of the occlusion and a C2 laminar screw on the dominant side combined with a bilateral atlas hook. The transarticular screw was inserted using a navigation system and image intensifier, and the laminar screw was inserted free hand. Bone grafting from the iliac crest was performed. Conclusion: Transarticular and C2 laminar screws fixation combined with the atlas hook in a patient with unilateral VA occlusion is a useful technique, in order to reduce the risk of further VA injury.

Original languageEnglish
Pages (from-to)25-27
Number of pages3
JournalArchives of Orthopaedic and Trauma Surgery
Volume129
Issue number1
DOIs
Publication statusPublished - 2009

Fingerprint

Vertebral Artery
Atlases
Safety
Wounds and Injuries
Neck Pain
Atlanto-Axial Fusion
Bone Transplantation
Spinal Cord Diseases
Angiography
Hand

Keywords

  • Atlantoaxial subluxation
  • Atlas hook
  • Laminar screw
  • Occlusion
  • Rheumatoid arthritis
  • Vertebral artery

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

@article{1b0a2d75bad646beb5017c53de0f8bc7,
title = "Safety of atlantoaxial fusion using laminar and transarticular screws combined with an atlas hook in a patient with unilateral vertebral artery occlusion (case report)",
abstract = "Objective and importance: A disadvantage of transarticular and C2 pedicle screws is vertebral artery (VA) injury as a result of screw misplacement. If unilateral occlusion of the VA is present, VA injury of the dominant side will cause fatal complications as a result of collateral flow insufficiency. Several authors have recently reported the usefulness of C2 laminar screws because of their safety on VA injury. We used transarticular and C2 laminar screws combined with the atlas hook in a patient with C1-2 instability and unilateral VA occlusion, in order to reduce the risk of further VA injury. Clinical presentation: A 64-year-old woman with rheumatoid atlantoaxial subluxation complained of cervical myelopathy and neck pain. Preoperative MR angiography showed a left side VA occlusion. Technique: The patient underwent atlantoaxial, posterior fusion using a transarticular screw on the side of the occlusion and a C2 laminar screw on the dominant side combined with a bilateral atlas hook. The transarticular screw was inserted using a navigation system and image intensifier, and the laminar screw was inserted free hand. Bone grafting from the iliac crest was performed. Conclusion: Transarticular and C2 laminar screws fixation combined with the atlas hook in a patient with unilateral VA occlusion is a useful technique, in order to reduce the risk of further VA injury.",
keywords = "Atlantoaxial subluxation, Atlas hook, Laminar screw, Occlusion, Rheumatoid arthritis, Vertebral artery",
author = "Yoshihisa Sugimoto and Masato Tanaka and Kazuo Nakanishi and Haruo Misawa and Tomoyuki Takigawa and Yasuo Ito and Toshihumi Ozaki",
year = "2009",
doi = "10.1007/s00402-007-0510-9",
language = "English",
volume = "129",
pages = "25--27",
journal = "Archiv fur orthopadische und Unfall-Chirurgie",
issn = "0003-9330",
publisher = "Springer Verlag",
number = "1",

}

TY - JOUR

T1 - Safety of atlantoaxial fusion using laminar and transarticular screws combined with an atlas hook in a patient with unilateral vertebral artery occlusion (case report)

AU - Sugimoto, Yoshihisa

AU - Tanaka, Masato

AU - Nakanishi, Kazuo

AU - Misawa, Haruo

AU - Takigawa, Tomoyuki

AU - Ito, Yasuo

AU - Ozaki, Toshihumi

PY - 2009

Y1 - 2009

N2 - Objective and importance: A disadvantage of transarticular and C2 pedicle screws is vertebral artery (VA) injury as a result of screw misplacement. If unilateral occlusion of the VA is present, VA injury of the dominant side will cause fatal complications as a result of collateral flow insufficiency. Several authors have recently reported the usefulness of C2 laminar screws because of their safety on VA injury. We used transarticular and C2 laminar screws combined with the atlas hook in a patient with C1-2 instability and unilateral VA occlusion, in order to reduce the risk of further VA injury. Clinical presentation: A 64-year-old woman with rheumatoid atlantoaxial subluxation complained of cervical myelopathy and neck pain. Preoperative MR angiography showed a left side VA occlusion. Technique: The patient underwent atlantoaxial, posterior fusion using a transarticular screw on the side of the occlusion and a C2 laminar screw on the dominant side combined with a bilateral atlas hook. The transarticular screw was inserted using a navigation system and image intensifier, and the laminar screw was inserted free hand. Bone grafting from the iliac crest was performed. Conclusion: Transarticular and C2 laminar screws fixation combined with the atlas hook in a patient with unilateral VA occlusion is a useful technique, in order to reduce the risk of further VA injury.

AB - Objective and importance: A disadvantage of transarticular and C2 pedicle screws is vertebral artery (VA) injury as a result of screw misplacement. If unilateral occlusion of the VA is present, VA injury of the dominant side will cause fatal complications as a result of collateral flow insufficiency. Several authors have recently reported the usefulness of C2 laminar screws because of their safety on VA injury. We used transarticular and C2 laminar screws combined with the atlas hook in a patient with C1-2 instability and unilateral VA occlusion, in order to reduce the risk of further VA injury. Clinical presentation: A 64-year-old woman with rheumatoid atlantoaxial subluxation complained of cervical myelopathy and neck pain. Preoperative MR angiography showed a left side VA occlusion. Technique: The patient underwent atlantoaxial, posterior fusion using a transarticular screw on the side of the occlusion and a C2 laminar screw on the dominant side combined with a bilateral atlas hook. The transarticular screw was inserted using a navigation system and image intensifier, and the laminar screw was inserted free hand. Bone grafting from the iliac crest was performed. Conclusion: Transarticular and C2 laminar screws fixation combined with the atlas hook in a patient with unilateral VA occlusion is a useful technique, in order to reduce the risk of further VA injury.

KW - Atlantoaxial subluxation

KW - Atlas hook

KW - Laminar screw

KW - Occlusion

KW - Rheumatoid arthritis

KW - Vertebral artery

UR - http://www.scopus.com/inward/record.url?scp=56249144197&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=56249144197&partnerID=8YFLogxK

U2 - 10.1007/s00402-007-0510-9

DO - 10.1007/s00402-007-0510-9

M3 - Article

C2 - 18034252

AN - SCOPUS:56249144197

VL - 129

SP - 25

EP - 27

JO - Archiv fur orthopadische und Unfall-Chirurgie

JF - Archiv fur orthopadische und Unfall-Chirurgie

SN - 0003-9330

IS - 1

ER -