Axis Screw Fixation – A Step-by-Step Review of the Surgical Techniques

Abstract

In this article, we present the techniques of axis screw fixation (laminar, pars, pedicle and transarticular screws), discussing the indications and contraindications of each one, as well as surgical tips and anatomical landmarks.

Resumo

No presente artigo, apresentamos as técnicas de fixação do áxis com parafusos (lamina, parafusos de pars, pedículo e transarticular), discutindos as indicações e contra-indicações das mesmas, assim como dicas cirúrgicas e parâmetros anatômicos relevantes.

Keywords

axis - screw - lamina - pars - pedicle - transarticular

Palavras-chave

áxis - parafuso - lâmina - pars - pedículo - transarticular

Quiz – Additional Information for Residents (supplementary material)

• References

• 1 Joaquim AF, Ghizoni E, Anderle DV, Oliveira Ed, Tedeschi H. Axis instrumentation: surgical results. Arq Neuropsiquiatr 2012; 70 (11) 857-863
• 2 Farey ID, Nadkarni S, Smith N. Modified Gallie technique versus transarticular screw fixation in C1-C2 fusion. Clin Orthop Relat Res 1999; (359) 126-135
• 3 Dickman CA, Sonntag VK. Posterior C1-C2 transarticular screw fixation for atlantoaxial arthrodesis. Neurosurgery 1998; 43 (02) 275-280 , discussion 280–281
• 4 Coyne TJ, Fehlings MG, Wallace MC, Bernstein M, Tator CH. C1-C2 posterior cervical fusion: long-term evaluation of results and efficacy. Neurosurgery 1995; 37 (04) 688-692 , discussion 692–693
• 5 Rajinda P, Towiwat S, Chirappapha P. Comparison of outcomes after atlantoaxial fusion with C1 lateral mass-C2 pedicle screws and C1-C2 transarticular screws. Eur Spine J 2016 Oct 2
• 6 Jeanneret B, Magerl F. Primary posterior fusion C1/2 in odontoid fractures: indications, technique, and results of transarticular screw fixation. J Spinal Disord 1992; 5 (04) 464-475
• 7 Ebrahein NA, Fow J, Xu R, Yeasting RA. The location of the pedicle and pars interarticularis in the axis. Spine 2001; 26 (04) 34-37
• 8 Wright NM. Posterior C2 fixation using bilateral, crossing C2 laminar screws: case series and technical note. J Spinal Disord Tech 2004; 17 (02) 158-162
• 9 Mandel IM, Kambach BJ, Petersilge CA, Johnstone B, Yoo JU. Morphologic considerations of C2 isthmus dimensions for the placement of transarticular screws. Spine 2000; 25 (12) 1542-1547
• 10 Igarashi T, Kikuchi S, Sato K, Kayama S, Otani K. Anatomic study of the axis for surgical planning of transarticular screw fixation. Clin Orthop Relat Res 2003; (408) 162-166
• 11 Singh B, Cree A. Laminar screw fixation of the axis in the pediatric population: a series of eight patients. Spine J 2015; 15 (02) e17-e25
• 12 Hong JT, Yi JS, Kim JT, Ji C, Ryu KS, Park CK. Clinical and radiologic outcome of laminar screw at C2 and C7 for posterior instrumentation--review of 25 cases and comparison of C2 and C7 intralaminar screw fixation. World Neurosurg 2010; 73 (02) 112-118 , discussion e15
• 13 Cassinelli EH, Lee M, Skalak A, Ahn NU, Wright NM. Anatomic considerations for the placement of C2 laminar screws. Spine 2006; 31 (24) 2767-2771
• 14 Cristante AF, Torelli AG, Kohlmann RB. , et al. Feasibility of intralaminar, lateral mass, or pedicle axis vertebra screws in children under 10 years of age: a tomographic study. Neurosurgery 2012; 70 (04) 835-838 , discussion 838–839
• 15 Joaquim AF, Ghizoni E, Rubino PA. , et al. Lateral mass screw fixation of the atlas: surgical technique and anatomy. World Neurosurg 2010; 74 (2-3): 359-362
• 16 Mudo ML, Amantéa AV, Cavalheiro S, Joaquim AF. Intraoperative radiological visualization of the occipito-cervical transition and upper cervical spine: technical note. Columna 2009; 8: 197-199
• 17 Yanni DS, Perin NI. Fixation of the axis. Neurosurgery 2010; 66 (3, Suppl) 147-152
• 18 Menendez JA, Wright NM. Techniques of posterior C1-C2 stabilization. Neurosurgery 2007; 60 (01) (Suppl. 01) S103-S111
• 19 Puschak TJ, Anderson PA. Posterior C1–C2 Transarticular Screws. Tech Orthop 2002; 17 (03) 296-305
• 20 Sciubba DM, Noggle JC, Vellimana AK. , et al. Radiographic and clinical evaluation of free-hand placement of C-2 pedicle screws. Clinical article. J Neurosurg Spine 2009; 11 (01) 15-22
• 21 Lehman Jr RA, Dmitriev AE, Helgeson MD, Sasso RC, Kuklo TR, Riew KD. Salvage of C2 pedicle and pars screws using the intralaminar technique: a biomechanical analysis. Spine 2008; 33 (09) 960-965
• 22 Parker SL, McGirt MJ, Garcés-Ambrossi GL. , et al. Translaminar versus pedicle screw fixation of C2: comparison of surgical morbidity and accuracy of 313 consecutive screws. Neurosurgery 2009; 64 (05) (Suppl. 02) 343-348 , discussion 348–349