Indirect Decompression using Segmental Screw Fixation for Cervical Myelopathy Caused by C1-2 Subluxation: Technical Note / 대한정형외과학회잡지

The main aims of surgery for severe cord compression and myelopathy caused by atlantoaxial subluxation are decompression of the spinal cord and achievement of rigid fixation and fusion. Direct decompression by resecting the bony structures that compress the spinal cord includes transoral decompression and resection of the posterior arch of the atlas. The shortcomings of these procedures are a high complication rate and a relatively low rate of union. Indirect decompression can be performed by a reduction of the subluxation and fixation without bone resection. To the best of our knowledge, there are no domestic reports on the use of indirect decompression for severe cord compression and myelopathy for atlantoaxial subluxation. We report a case of a patient that had atlantoaxial subluxation and severe myelopathy; satisfactory reduction of the subluxation and decompression with an improvement in the myelopathy symptoms was achieved by indirect decompression using segmental screw fixation.

Old Atlantoaxial Rotary Subluxation Associated with High-riding Vertebral Arteries: Arthrodesis Using C1 Lateral Mass Screws and C2 Laminar Screws: A Case Report

To the best of our knowledge, there has been no domestic report on posterior atlantoaxial fusion with segmental screw fixation using C2 laminar screws and C1 lateral mass screws for atlantoaxial subluxation. We report the result of this operation performed in a patient with old atlantoaxial rotary subluxation who required posterior fusion. We chose this technique in this patient because wire fixation was not suitable due to osteoporosis, and transarticular screw fixation and use of C2 pedicle screws were not feasible due to the peculiar bony anatomy of the axis.

Atlantoaxial Fixation using C2 Subarticular Screws and C1 Lateral Mass Screws : A Technical Report / 대한정형외과학회잡지

Segmental screw fixation is a useful procedure for the surgical treatment of atlantoaxial subluxation. Currently, C1 lateral mass screws and C2 pedicle screws are the standard screws used in this procedure. However, the C2 pedicle screw can cause serious complications such as vertebral artery injury. Recently we suggested a new trajectory for the C2 screw, the subarticular screw, which has a lower probability of vertebral artery injury compared with the pedicle screw, based on a study using 1 mm-sliced CT scan images and simulation software. We report the first case of segmental screw fixation using C2 subarticular screws along with C1 lateral mass screws. The patient had atlantoaxial subluxation and myelopathy and showed satisfactory results after surgery.

C1-2 Fixation Using Polyaxial Screws and Rods Assisted by Computer Simulation for Revision of Failed Posterior Fusion: A Technical Report / 대한정형외과학회잡지

Segmental C1-2 screw fixation using C1 lateral mass screws and C2 pedicle screws is a technically demanding procedure which can cause injuries to the vertebral artery or neural structures as well as massive bleeding from the epidural venous plexus. In particular, this procedure is more difficult in revision cases because of the lack of normal anatomical landmarks, adhesion, and bleeding. The authors report a case of a patient in whom preoperative surgical simulation and planning using computer software was very helpful in the direct screwing of the atlas and axis for a revision of atlantoaxial fusion.