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.

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.

scholarly journals Is atlantoaxial instability the cause of Chiari malformation? Outcome analysis of 65 patients treated by atlantoaxial fixation

2015 ◽  
Vol 22 (2) ◽  
pp. 116-127 ◽  
Author(s):  
Atul Goel
Keyword(s):  
Chiari Malformation ◽  
Basilar Invagination ◽  
Foramen Magnum ◽  
Neurological Function ◽  
Atlantoaxial Dislocation ◽  
Atlantoaxial Instability ◽  
Foramen Magnum Decompression ◽  
Atlantoaxial Fixation ◽  
Atlantoaxial Stabilization

OBJECT Understanding that atlantoaxial instability is the cause of Chiari malformation (CM), the author treated 65 patients using atlantoaxial stabilization. The results are analyzed. METHODS Cases of CM treated using atlantoaxial fixation during the period from January 2010 to November 2013 were reviewed and analyzed. Surgery was aimed at segmental arthrodesis. RESULTS The author treated 65 patients with CM in the defined study period. Fifty-five patients had associated syringomyelia. Forty-six patients had associated basilar invagination. Thirty-seven patients had both basilar invagination and syringomyelia. Three patients had been treated earlier using foramen magnum decompression and duraplasty. According to the extent of their functional capabilities, patients were divided into 5 clinical grades. On the basis of the type of facetal alignment and atlantoaxial instability, the patients were divided into 3 groups. Type I dislocation (17 patients) was anterior atlantoaxial instability wherein the facet of the atlas was dislocated anterior to the facet of the axis. Type II dislocation (31 patients) was posterior atlantoaxial instability wherein the facet of the atlas was dislocated posterior to the facet of the axis. Type III dislocation (17 patients) was the absence of demonstrable facetal malalignment and was labeled as “central” atlantoaxial dislocation. In 18 patients, dynamic images showed vertical, mobile and at-least partially reducible atlantoaxial dislocation. All patients were treated with atlantoaxial plate and screw fixation using techniques described in 1994 and 2004. Foramen magnum decompression or syrinx manipulation was not performed in any patient. Occipital bone and subaxial spinal elements were not included in the fixation construct. One patient died, and death occurred in the immediate postoperative phase and was related to a vertebral artery injury incurred during the operation. One patient had persistent symptoms. In the rest of the patients there was gratifying clinical improvement. More remarkably, in 7 patients, the symptoms of lower cranial nerve paresis improved. No patient worsened in their neurological function after surgery. Reductions in the size of the syrinx and regression of the CM were observed in 6 of 11 cases in which postoperative MRI was possible. During the follow-up period, there was no delayed worsening of neurological function or symptoms in any patient. Sixty-three patients improved after surgery, and the improvement was sustained during the average follow-up period of 18 months. CONCLUSIONS On the basis of outcomes in this study, it appears that the pathogenesis of CM with or without associated basilar invagination and/or syringomyelia is primarily related to atlantoaxial instability. The data suggest that the surgical treatment in these cases should be directed toward atlantoaxial stabilization and segmental arthrodesis. Except in cases in which there is assimilation of the atlas, inclusion of the occipital bone is neither indicated nor provides optimum stability. Foramen magnum decompression is not necessary and may be counter-effective in the long run.

Craniocervical Instability in the Setting of Os Odontoideum

Neurosurgery ◽  
2015 ◽  
Vol 76 (5) ◽  
pp. 514-521 ◽  
Author(s):  
Deng Zhao ◽  
Shenglin Wang ◽  
Peter G. Passias ◽  
Chao Wang
Keyword(s):  
Surgical Management ◽  
Japanese Orthopaedic Association ◽  
Os Odontoideum ◽  
Complication Rates ◽  
Computed Tomographic ◽  
Presenting Symptoms ◽  
Functional Scores ◽  
Atlantoaxial Fixation ◽  
History Of

Abstract BACKGROUND: Our clinical understanding of os odontoideum (OO) remains incomplete. Congenital and traumatic causes have been proposed and advocated. Clinical presentations range from asymptomatic to axial pain to myelopathy or vertebral-basilar ischemia. A consensus for surgical management exists for those found to have an unstable atlantoaxial complex or symptomatic cranial-vertebral junction compression. OBJECTIVE: To evaluate the clinical presentation and surgical outcomes of patients with OO and an unstable atlantoaxial complex or symptomatic cranial-vertebral junction compression. METHODS: Patients with a diagnosis of OO who underwent surgical management were included. Patients were excluded on the basis of previous C2 fracture, Fielding diagnostic criteria, and inadequate follow-up. History of trauma and presenting symptoms were assessed. Clinical and neurological improvements were measured with the use of patient satisfaction scores and the Japanese Orthopaedic Association scores. Fusion status was documented with the use of radiographs and computed tomographic imaging. RESULTS: Of 279 patients, 112 reported a history of cranial-vertebral junction trauma, whereas 28 were diagnosed with congenital malformations. Clinically, 84.9% of patients presented with myelopathy, with pain presented in 42.6%. Atlantoaxial fixation was performed in 240 patients, occiput-to-C2 fixation in 35 patients, and extended occipito-cervical fixation in 4 patients. Mean follow-up was 40.3 months. Complications were reported in 2.4% of patients. Japanese Orthopaedic Association scores improved from a preoperative mean of 12.4 to 14.8. Two hundred thirty-five patients (77.7%) improved, with 30 patients experiencing no change in symptoms and 14 patients deteriorating. Fusion was achieved in 96.8% of patients. CONCLUSION: Our data reveal that surgical treatment for OO using the indications and techniques delineated is associated with high satisfaction rates, improved functional scores, and high fusion rates with low complication rates.

scholarly journals Short segment pedicle screw fixation of thoracolumbar fracture: a case series of 33 patients

2017 ◽  
Vol 3 (4) ◽  
pp. 681
Author(s):  
Naushad Hussain ◽  
Nirmal Dhananjay Patil ◽  
Hiren Patel ◽  
Akash Shakya
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Wedge Angle ◽  
Body Height ◽  
Pedicle Screw Fixation ◽  
Thoracolumbar Fracture ◽  
Vertebral Body Height ◽  
Short Segment ◽  
Screw Insertion

<p class="abstract"><strong>Background:</strong> Pedicle screw instrumentation in case of fracture spine provides stable fixation. However in absence of experience and proper technique of pedicle screw insertion, it is associated with many complications. We aim to study the results of patients with thoracolumbar fracture stabilized with short segment pedicle screw instrumentation.</p><p class="abstract"><strong>Methods:</strong> 33 cases of thoracolumbar wedge compression fracture spine presenting to Nair Hospital were included in the study. All patients were operated by the senior author via a posterior approach and short segment pedicle screw fixation. Patients were followed up for one year.<strong></strong></p><p class="abstract"><strong>Results:</strong> 33 patients with a mean age were 37.6 years of which 3 were females and 30 were males in our study. Fall from height (93.93%) was the most common mode of injury followed by road traffic accident (6.07%). D12 and L1 were the most common vertebrae involved. Statistically significant (p=0.01) correction in the vertebral body height occurred in the immediate postop period and there was 4.1% loss of correction at final follow-up. There was statistically significant improvements in the Regional angle (p=0.03) and anterior wedge angle (p=0.03). Residual regional angle at final follow-up was found to be &gt;5° in 3 patients. Neurological improvement was seen in 23 (74.19%) patients (p=0.01). No improvements were seen in 8 (25.81%) patients. None of our patients had postoperative worsening of the neurological status. None of the patients had pedicle wall breach on final follow up CT scan.</p><p class="abstract"><strong>Conclusions:</strong> Short segment fixation in case of wedge fracture can restore the vertebral body height, mean regional angle and mean anterior wedge angle and provide good outcome. There are poor chances of recovery of patient with Frankel grade A. Meticulous dissection and careful technique of pedicle screw insertion, adequate decompression, good contouring of the rod with correction of kyphosis can provide excellent results.</p>

scholarly journals C1-C2 screw fixation in the patient with anomalous course of vertebral artery: Case report

2019 ◽  
Vol 76 (5) ◽  
pp. 555-558 ◽  
Author(s):  
Drazen Ivetic ◽  
Goran Pavlicevic ◽  
Branislav Antic
Keyword(s):  
Case Report ◽  
Vertebral Artery ◽  
Screw Fixation ◽  
Atlantoaxial Instability ◽  
Complicated Structure ◽  
Neurological Improvement ◽  
Degenerative Disorders ◽  
Translaminar Screw ◽  
Atlantoaxial Fixation ◽  
Alternative Fixation

Introduction. The atlantoaxial complex is a very complicated structure and open reduction of C1-C2 subluxation is very demanding. Atlantoaxial instability may result from the traumatic, inflammatory, neoplastic, congenital or degenerative disorders. Anatomy of the vertebral artery is essential for surgical approach and sometimes the placement of C2 pedicle screw is not possible. In these instances, the translaminar screw placement in C2 can provide an alternative fixation point in C2, without threatening injury to the vertebral artery. Case report. We presented 54- year-old patient with cervical myelopathy according to traumatic atlantoaxial subluxation. Computed tomography angiography showed a bilateral vertebral artery anomaly of ?high-riding? type. The patient was operated and the posterior C1-C2 screws fixation was used. Due to the vertebral artery anomaly C2 screws were translaminary inserted. Complete reduction of C1-C2 subluxation and excellent neurological improvement were achieved. Conclusion. Surgical treatment of C1-C2 subluxation is very challenging. Many techniques of atlantoaxial fixation have been developed. The use of C2 translaminar screw is an alternative method of fixation in the treatment of atlantoaxial instability, especially in cases with the vertebral artery anomaly.

scholarly journals Effects of different pedicle screw insertion depths on sagittal balance of lumbar degenerative spondylolisthesis, a retrospective comparative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Quan Zhou ◽  
Jun-xin Zhang ◽  
Yi-fei Zheng ◽  
Yun Teng ◽  
Hui-lin Yang ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Sagittal Balance ◽  
Screw Fixation ◽  
Degenerative Spondylolisthesis ◽  
Leading Edge ◽  
Pedicle Screw Fixation ◽  
Screw Insertion ◽  
Lumbar Degenerative Spondylolisthesis ◽  
Screw Group

Abstract Background Few reports to date have evaluated the effects of different pedicle screw insertion depths on sagittal balance and prognosis after posterior lumbar interbody and fusion (PLIF) in patients with lumbar degenerative spondylolisthesis (LDS). Methods A total of 88 patients with single-level PLIF for LDS from January 2018 to December 2019 were enrolled. Long screw group (Group L): 52 patients underwent long pedicle screw fixation (the leading edge of the screw exceeded 80% of the anteroposterior diameter of vertebral body). Short screw group (Group S): 36 patients underwent short pedicle screw fixation (the leading edge of the screw was less than 60% of the anteroposterior diameter of vertebral body). Local deformity parameters of spondylolisthesis including slip degree (SD) and segment lordosis (SL), spino-pelvic sagittal plane parameters including pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and lumbar lordosis (LL), Oswestry Disability Index (ODI), and Visual Analog Scale (VAS) for back pain of both groups were compared. Postoperative complications, including vertebral fusion rate and screw loosening rate, were recorded. Results Except that PI in Group S at the final follow-up was not statistically different from the preoperative value (P > 0.05), other parameters were significantly improved compared with preoperative values one month after surgery and at the final follow-up (P < 0.05). There was no significant difference in parameters between Group L and Group S before and one month after surgery (P > 0.05). At the final follow-up, SD, SL, LL, PT and PI-LL differed significantly between the two groups (P < 0.05). Compared with the preoperative results, ODI and VAS in both groups decreased significantly one month after surgery and at the final follow-up (P < 0.05). Significant differences of ODI and VAS were found between the two groups at the final follow-up (P < 0.05). Postoperative complications were not statistically significant between the two groups (P > 0.05). Conclusions PLIF can significantly improve the prognosis of patients with LDS. In terms of outcomes with an average follow-up time of 2 years, the deeper the screw depth is within the safe range, the better the spino-pelvic sagittal balance may be restored and the better the quality of life may be.

scholarly journals Atlantoaxial Stabilization Using C1 and C2 Laminar Screw Fixation

2017 ◽  
Vol 11 (2) ◽  
pp. 314-318 ◽  
Author(s):  
Takashi Tsuji ◽  
Kazuhiro Chiba ◽  
Yosuke Horiuchi ◽  
Tadahisa Urabe ◽  
Shota Fujita ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Lower Risk ◽  
Screw Fixation ◽  
Artery Occlusion ◽  
Cervical Spine Fracture ◽  
Atlantoaxial Joint ◽  
Laminar Screw ◽  
Combined Use ◽  
Atlantoaxial Stabilization ◽  
C2 Laminar Screw

<p>We describe the use of a C1 laminar screw in combination with a C2 laminar screw as a salvage technique to treat two patients, one with persistent first intersegmental artery and the other with vertebral artery occlusion after cervical spine fracture. The combined use of C1 and C2 laminar screws allows for good fixation of the atlantoaxial joint with a lower risk of vertebral artery injury; therefore, it can be an alternative surgical procedure for patients with congenital or traumatic anomalous vertebral artery.</p>

scholarly journals Mobilization of the high-riding vertebral artery for C2 screw insertion

2020 ◽  
Vol 3 (1) ◽  
pp. V4
Author(s):  
Atul Goel
Keyword(s):  
Articular Cartilage ◽  
Bone Graft ◽  
Vertebral Artery ◽  
Screw Insertion ◽  
Link Type ◽  
Alternative Option ◽  
Atlantoaxial Fixation

The basic surgical steps in the Goel technique of atlantoaxial fixation involve exposure of the atlantoaxial articulation, denuding of the articular cartilage, stuffing of bone graft pieces within the articular cavity, and subsequent instrumentation.“High-riding” vertebral artery in relationship to the pedicle-facet of C2 has been widely recognized to be a factor that makes insertion of the C2 pedicle-facet screw difficult or impossible. In this video, a technique of exposure and mobilization of the high-riding vertebral artery to permit safe C2 screw insertion is shown. An alternative option in the presence of such a high-riding vertebral artery is to use either C2 laminar or inferior facetal screw insertion.The video can be found here: https://youtu.be/LjxxINmzph0

scholarly journals Single-center series of boys with recurrent strokes and rotational vertebral arteriopathy

Neurology ◽  
2020 ◽  
Vol 95 (13) ◽  
pp. e1830-e1834
Author(s):  
Christine K. Fox ◽  
Heather J. Fullerton ◽  
Steven W. Hetts ◽  
Van V. Halbach ◽  
Kurtis I. Auguste ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Vertebral Artery ◽  
Recurrent Stroke ◽  
Head Rotation ◽  
Os Odontoideum ◽  
Stroke Recurrence ◽  
Pediatric Stroke ◽  
Activity Restriction ◽  
Tissue Abnormalities

ObjectiveTo describe a pediatric stroke syndrome with chronic focal vertebral arteriopathy adjacent to cervical abnormalities.MethodsAt a single pediatric stroke center, we identified consecutive children with stroke and vertebral arteriopathy of the V3 segment with adjacent cervical bony or soft tissue abnormalities. We abstracted clinical presentation, treatment, and follow-up data from medical charts.ResultsFrom 2005 to 2019, 10 children (all boys, ages 6–16 years) presented with posterior circulation strokes and vertebral arteriopathy with adjacent cervical pathology. Two children had bony abnormalities: one had a congenital arcuate foramen and one had os odontoideum with cervical instability. In children without bony pathology, vertebral artery narrowing during contralateral head rotation was visualized by digital subtraction angiography. Eight boys had recurrent ischemic events despite anti-thrombotic treatment (including 5 with multiple recurrences) and were treated surgically to prevent additional stroke. Procedures included vertebral artery decompression (n = 6), endovascular stent and spinal fusion (n = 1), and vertebral artery endovascular occlusion (n = 1). In boys treated with decompression, cervical soft tissue abnormalities (ruptured atlantoaxial bursa, ruptured joint capsule, or connective tissue scarring) were directly visualized during open surgery. No other etiology for stroke or dissection was found in any of the cases. Two boys without recurrent stroke were treated with activity restriction and antithrombotics. At a median follow-up of 51 months (range 17–84), there have been no additional recurrences.ConclusionsChildren with V3 segmental vertebral arteriopathy frequently have stroke recurrence despite antithrombotics. Cervical bone imaging and angiography with neck rotation can identify underlying pathology.

Sign in / Sign up

Export Citation Format

Share Document