ABSTRACT
STUDY DESIGN: Retrospective case series. PURPOSE: To evaluate surgical outcomes and effectiveness of an autogenic rib graft for upper cervical fixation in pediatric patients. OVERVIEW OF LITERATURE: Autogenic bone grafts have long been considered the ‘gold standard’ bone source for posterior cervical fusion in pediatric patients. However, there are some unsolved problems associated with donor-site morbidity and amount of bone grafting. METHODS: We studied five consecutive pediatric patients who underwent atlantoaxial fixation or occipitocervical fixation (OCF) using an autogenic rib graft with at least 2 years of follow-up (mean age, 9.8 years; mean follow-up period, 73.0 months). Two patients underwent OCF without screw-rod constructs and three patients with screw-rod constructs. Autogenic rib grafts were used in all patients. We evaluated the surgical outcomes including radiographic parameter, bony union, and perioperative complications. RESULTS: The atlantoaxial interval (ADI) was corrected from 11.6 to 6.0 mm, and the C1–2 angle was corrected −14.8° to 7.8°. The C2–7 angle was reduced from 31° to 9° spontaneously. Two patients with OCF required revision surgery due to loss of correction. Patients did not experience any complication associated with the donor sites (rib bone grafts). Six months postoperation X-rays clearly showed regeneration of the rib at the donor sites. Bony fusion was achieved in all patients; however, bony fusion occurred more slowly in patients without screw-rod constructs compared with patients with screw-rod constructs. Bone regeneration of the rib was observed in all patients with no complications at the donor site. CONCLUSIONS: Autogenic rib grafts have advantages of potential bone regeneration, high fusion rate, and low donor-site morbidity. In addition, a screw-rod construct provides better bony fusion in pediatric patients with OCF and atlantoaxial fixation.
ABSTRACT
The crossing laminar screw fixation might be the most recently developed approach among various fixation techniques for C2. The new construct has stability comparable to transarticular or transpedicular screw fixation without risk of vertebral artery injury. Quantitative anatomical studies about C2 vertebra suggest significant variation in the thickness of C2 lamina as well as cross sectional area of junction of lamina and spinous process. We present an elderly patient who underwent an occipito-cervical stabilization incorporating crossed C2 laminar screw fixation. We preoperatively recognized that she had low profiles of C2 lamina, and thus made a modification of trajectory for the inferiorly crossing screw. We introduce a simple modification of crossing C2 laminar screw technique to improve stability in patients with low laminar profiles.
Subject(s)
Aged , Humans , Spine , Vertebral ArteryABSTRACT
[Objective]To report the initial outcomes of occipitocervical fixation using plate-rod-polyaxial screw system and investigate whether this new system offers any advantage over other existing methods of fixation.[Method]Fourteen cases(male 9,female 5)accepted cervicooccipital fixation with plate-rod-polyaxial screw system.There were 3 cases of odontoid dysplasia with dislocation;spinal canal tumor in 3;2 cases of metastatic carcinoma with pathologic fracture of C_1 and C_2,rheumatoid arthritis with cervicooccipital instability,and fasilar impression;burst fracture of C_1 with oecipital-atlantal-axial instability in 1.Twelve cases had neck pain.Thirteen cases had neurological deficits in different degrees.JOA score was 12.4 on average.[Result]The positions of all screws were good.There was no complication related to inserting screws.All neck pain released.Fourteen-months follow-up was obtained on average in 13 patients.Cervicooccipital nonunion was in one case and its occipital screws were pulled out.Twelve patients had satisfactory fixation and got firm fusion.Ameliotate rate of JOA score of the neurological function was 63.0%.[Conclusion]These initial data indicate that posterior occipitocervical fixation using plate-rod-polyaxial screw system is safe and reliable,and satisfactory clinical outcome can be obtained.The system appears to offer some advantages over other existing methods of fixation.