Transarticular Fixation Following Mobilization of “High-Riding” Vertebral Artery

2021 ◽  
Author(s):  
Atul Goel ◽  
Apurva Prasad ◽  
Abhidha Shah ◽  
Sumeet Sasane ◽  
Akshay Hawaldar ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Screw Fixation ◽  
Basilar Invagination ◽  
Transarticular Screw ◽  
Posterior Aspect ◽  
Screw Insertion ◽  
Transarticular Screw Fixation ◽  
History Of ◽  
C2 Vertebra ◽  
Transarticular Fixation

Abstract BACKGROUND AND IMPORTANCE: The article identifies the feasibility of transarticular screw fixation after mobilizing the vertebral artery in cases where it is in a “high-riding” location. CLINICAL PRESENTATION: A 42-yr-old male patient had a 4-yr history of progressive quadriparesis. Investigations revealed severe basilar invagination. There was assimilation of atlas and C2-3 fusion. The vertebral artery was “high-riding” into the pedicle-facet of C2 vertebra on both sides. Vertebral artery loop was exposed and mobilized inferiorly on both sides after careful drilling of pedicular bone on the posterior aspect of the dome of the artery. C2 facetal bone on the anterior face of the vertebral artery dome was now available for screw insertion. The C1-2 facets and the articulation were directly in line, making transarticular screw fixation relatively straightforward. The wide bone space available permitted insertion of 2 screws in a transarticular fashion on both sides. The patient had satisfactory clinical improvement. Imaging after 22 mo showed bone fusion across the facets. CONCLUSION: Mobilization of the high-riding vertebral artery loop can help salvage the surgical procedure of lateral mass stabilization.

Mobilization of the Vertebral Artery—Surgical Option for C2 Screw Fixation in Cases With “High Riding” Vertebral Artery

2019 ◽  
Vol 18 (6) ◽  
pp. 648-651 ◽  
Author(s):  
Atul Goel ◽  
Ranjit Rangnekar ◽  
Abhidha Shah ◽  
Survendra Rai ◽  
Ravikiran Vutha
Keyword(s):  
Vertebral Artery ◽  
Screw Fixation ◽  
Basilar Invagination ◽  
Os Odontoideum ◽  
Safe Procedure ◽  
Screw Insertion ◽  
Atlantoaxial Fixation ◽  
Atlantoaxial Stabilization ◽  
C2 Vertebra

Abstract BACKGROUND Mobilization of intraosseous course of vertebral artery for safe screw insertion into pedicle of axis in cases with high riding vertebral artery is discussed. OBJECTIVE To show drilling, exposure, and mobilization of the “high-riding” vertebral artery loop during its course in relationship with superior facet/pedicle of C2 vertebra can provide safety to techniques of atlantoaxial fixation that involve insertion of screws in the pars/pedicle/facet of C2. METHODS During the period June 2016 to April 2018, 15 patients operated for atlantoaxial stabilization underwent vertebral artery exposure and mobilization using the technique discussed. The ages of the patients ranged from 6 to 48 yrs. Four patients had mobile and reducible atlantoaxial dislocation. Seven patients had basilar invagination. Four patients had os-odontoideum. Gentle and precise drilling of bone that covers the “high-riding” vertebral artery can lead to its safe and wide surgical exposure. The arterial loop can then be either completely or partially mobilized out of the vertebral artery groove such that C2 screw insertion can be conducted under direct surgical visualization of the vertebral artery. RESULTS During the average follow-up period of 14 mo, there have been no complications related to the surgical procedure, metal implant, or vertebral artery. CONCLUSION Vertebral artery exposure and mobilization is rather simple and safe procedure and is remarkably effective in providing a space for C2 screw implantation.

Atlantoaxial Transarticular Screw Fixation for a High-Riding Vertebral Artery

Spine ◽  
2003 ◽  
Vol 28 (7) ◽  
pp. 666-670 ◽  
Author(s):  
Masashi Neo ◽  
Mutsumi Matsushita ◽  
Yasushi Iwashita ◽  
Tadashi Yasuda ◽  
Takeshi Sakamoto ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Screw Fixation ◽  
Transarticular Screw ◽  
Transarticular Screw Fixation

Arteriovenous fistula as a complication of C1–2 transarticular screw fixation

1996 ◽  
Vol 85 (2) ◽  
pp. 340-343 ◽  
Author(s):  
Domagoj Coric ◽  
Charles L. Branch ◽  
John A. Wilson ◽  
James C. Robinson
Keyword(s):  
Vertebral Artery ◽  
Arteriovenous Fistula ◽  
Screw Fixation ◽  
Atlantoaxial Instability ◽  
Unusual Complication ◽  
Venous Plexus ◽  
Fixation Technique ◽  
Transarticular Screw ◽  
Content Type ◽  
Transarticular Fixation

✓ A case is reported of a vertebral artery-to-epidural venous plexus fistula as a complication of posterior atlantoaxial facet screw fixation. The use of transarticular screws to stabilize the C1–2 joint has become an increasingly popular fixation technique, most notably for atlantoaxial instability due to trauma or rheumatoid disease. Despite the fact that this approach is technically challenging, there have been few reports of complications associated with C1–2 transarticular fixation. Although damage to the vertebral artery is a documented hazard of transarticular fixation at this level, a symptomatic arteriovenous fistula resulting from the procedure has not been described previously. The etiology, presentation, and treatment of this unusual complication are discussed.

Biomechanical Comparison of Two Atlantoaxial Arthrodeses in a Cadaveric Spine Model: Transarticular Screw Fixation Versus Screw and Rod Fixation

2002 ◽  
Author(s):  
V. K. Goel ◽  
H. Kuroki ◽  
S. Holekamp ◽  
V. Pitka¨nen ◽  
S. Rengachary ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Screw Fixation ◽  
Atlantoaxial Instability ◽  
Transarticular Screw ◽  
Transarticular Screw Fixation ◽  
Risk Of Injury ◽  
Spine Model ◽  
Fixation Techniques ◽  
A New Technique ◽  
Biomechanical Comparison

The causes of atlantoaxial instability include trauma, tumor, congenital malformation, or rheumatoid arthritis. Commonly available fixation techniques to stabilize the atlantoaxial complex are several posterior wiring procedures (Brooks fusion, Gallie fusion), transarticular screw procedure (Magerl technique), either alone or in combination. Wiring procedures are obviously easier to accomplish however these do not provide sufficient immobilization across the atlantoaxial complex1,3,4. On the other hand, although transarticular screw fixation (TSF) affords a much stiffer atlantoaxial arthrodesis than posterior wiring procedures. However, TSF has some drawbacks; for example the injury of vertebral artery. Furthermore, body habitus (obesity or thoracic kyphosis) may prevent from achieving the low angle needed for correct placement of screws between C1 and C2. Recently, a new technique of screw and rod fixation (SRF) that minimizes the risk of injury to the vertebral artery and allows intraoperative reduction has been reported2,6. The purpose of this study was to compare the biomechanical stability imparted to the C1 and C2 vertebrae by either TSF or SRF technique in a cadaver model.

Sign in / Sign up

Export Citation Format

Share Document