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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(01): 048-057
DOI: 10.1055/s-0042-1744502
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Posterior Atlantoaxial Screw Placement in a Portuguese Population: A Morphometric Analysis Based on Computed Tomography Scan Measurements

Article in several languages: português | English
Rita Santos Martins 
1   Departamento de Ortopedia, Centro Hospitalar Universitário do Porto, Porto, Portugal
2   Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
,
Catarina Silva Pereira 
1   Departamento de Ortopedia, Centro Hospitalar Universitário do Porto, Porto, Portugal
,
Carolina Lemos 
2   Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
3   Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
,
Ricardo Rodrigues-Pinto 
1   Departamento de Ortopedia, Centro Hospitalar Universitário do Porto, Porto, Portugal
2   Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
4   Unidade Vertebro-Medular, Departamento de Ortopedia, Centro Hospitalar Universitário do Porto, Porto, Portugal
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Abstract

Objective The present study aims to evaluate the screw length and trajectory angles for posterior atlantoaxial fixation in a Portuguese population, through the study of cervical computed tomography (CT) scans.

Methods Cervical CT scans of 50 adults were measured according to predefined screw trajectories of C1-C2 transarticular (C1C2TA), C1 lateral mass (C1LM), C2 pedicle (C2P), C2 pars and C2 laminar (C2L) screws. For each of these trajectories, screw length and angles were measured and compared between males and females.

Results For the C1C2TA screw trajectory, the mean length, medial, and cranial angles were 34.12 ± 3.19 mm, 6.24° ± 3.06, and 59.25° ± 5.68, respectively, and for the C1LM screw trajectory, they were 27.12 ± 2.15 mm, 15.82° ± 5.07, and 13.53° ± 4.80, respectively. The mean length, medial, and cranial angles for the C2P screw trajectory were 23.44 ± 2.49 mm, 27.40° ± 4.88, and 30.41° ± 7.27, respectively; and for the C2 pars screw trajectory, they were 16.84 ± 2.08 mm, 20.09° ± 6.83, and 47.53° ± 6,97. The mean length, lateral, and cranial angles for the C2L screw trajectory were 29.10 ± 2.48 mm, 49.80° ± 4.71, and 21.56° ± 7.76, respectively. There were no gender differences except for the lengths of the C1C2TA (p = 0,020) and C2L (p = 0,001) screws, which were greater in males than in females.

Conclusion The present study provides anatomical references for the posterior atlantoaxial fixation in a Portuguese population. These detailed data are essential to aid spine surgeons to achieve safe and effective screw placement.

Keywords

atlantoaxial joint - bone screws - cervical vertebrae - joint instability - surgical fixation devices

Financial Support

The authors have no financial disclosures to declare.


Work developed at the Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal.




Publication History

Received: 02 January 2022

Accepted: 20 January 2022

Article published online:
11 July 2022

© 2022. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • Referências

  • 1 Lopez AJ, Scheer JK, Leibl KE, Smith ZA, Dlouhy BJ, Dahdaleh NS. Anatomy and biomechanics of the craniovertebral junction. Neurosurg Focus 2015; 38 (04) E2
    Search in Google Scholar
  • 2 Yang SY, Boniello AJ, Poorman CE, Chang AL, Wang S, Passias PG. A review of the diagnosis and treatment of atlantoaxial dislocations. Global Spine J 2014; 4 (03) 197-210
    Search in Google Scholar
  • 3 Gautschi OP, Payer M, Corniola MV, Smoll NR, Schaller K, Tessitore E. Clinically relevant complications related to posterior atlanto-axial fixation in atlanto-axial instability and their management. Clin Neurol Neurosurg 2014; 123: 131-135
    Search in Google Scholar
  • 4 Lyons C, Ross M, Elliott R, Tall M. Atlantoaxial instability in a patient with neck pain and ankylosing spondylitis. Mil Med 2018; 183 (9-10): e654-e657
    Search in Google Scholar
  • 5 Chen Q, Brahimaj BC, Khanna R. et al. Posterior atlantoaxial fusion: a comprehensive review of surgical techniques and relevant vascular anomalies. J Spine Surg 2020; 6 (01) 164-180
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 7 Harms J, Melcher RP. Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976) 2001; 26 (22) 2467-2471
    Search in Google Scholar
  • 8 Huang D-G, Hao D-J, He B-R. et al. Posterior atlantoaxial fixation: a review of all techniques. Spine J 2015; 15 (10) 2271-2281
    Search in Google Scholar
  • 9 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
    Search in Google Scholar
  • 10 Liu S, Song Z, Liu L. et al. Biomechanical evaluation of C1 lateral mass and C2 translaminar bicortical screws in atlantoaxial fixation: an in vitro human cadaveric study. Spine J 2018; 18 (04) 674-681
    Search in Google Scholar
  • 11 Sugawara T, Higashiyama N, Kaneyama S, Sumi M. Accurate and Simple Screw Insertion Procedure With Patient-Specific Screw Guide Templates for Posterior C1-C2 Fixation. Spine (Phila Pa 1976) 2017; 42 (06) E340-E346
    Search in Google Scholar
  • 12 Du JY, Aichmair A, Kueper J, Wright T, Lebl DR. Biomechanical analysis of screw constructs for atlantoaxial fixation in cadavers: a systematic review and meta-analysis. J Neurosurg Spine 2015; 22 (02) 151-161
    Search in Google Scholar
  • 13 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 2017; 26 (04) 1064-1072
    Search in Google Scholar
  • 14 Nogueira-Barbosa MH, Defino HL. Multiplanar reconstructions of helical computed tomography in planning of atlanto-axial transarticular fixation. Eur Spine J 2005; 14 (05) 493-500
    Search in Google Scholar
  • 15 Lu X, Xu T. Advantages and Disadvantages of Traditional Atlantoaxial Fusion Techniques. In: Ni B, Guo X, Guo Q. eds. Atlantoaxial Fixation Techniques. Translational Medicine Research. Singapore: Springer; 2018: 39-48
    Search in Google Scholar
  • 16 Sim HB, Lee JW, Park JT, Mindea SA, Lim J, Park J. Biomechanical evaluations of various c1-c2 posterior fixation techniques. Spine (Phila Pa 1976) 2011; 36 (06) E401-E407
    Search in Google Scholar
  • 17 Blagg SE, Don AS, Robertson PA. Anatomic determination of optimal entry point and direction for C1 lateral mass screw placement. J Spinal Disord Tech 2009; 22 (04) 233-239
    Search in Google Scholar
  • 18 Simsek S, Yigitkanli K, Seçkin H. et al. Ideal screw entry point and projection angles for posterior lateral mass fixation of the atlas: an anatomical study. Eur Spine J 2009; 18 (09) 1321-1325
    Search in Google Scholar
  • 19 Christensen DM, Eastlack RK, Lynch JJ, Yaszemski MJ, Currier BL. C1 anatomy and dimensions relative to lateral mass screw placement. Spine (Phila Pa 1976) 2007; 32 (08) 844-848
    Search in Google Scholar
  • 20 Rocha R, Safavi-Abbasi S, Reis C. et al. Working area, safety zones, and angles of approach for posterior C-1 lateral mass screw placement: a quantitative anatomical and morphometric evaluation. J Neurosurg Spine 2007; 6 (03) 247-254
    Search in Google Scholar
  • 21 Hu Y, Dong WX, Spiker WR. et al. An anatomic study to determine the optimal entry point, medial angles, and effective length for safe fixation using posterior C1 lateral mass screws. Spine (Phila Pa 1976) 2015; 40 (04) E191-E198
    Search in Google Scholar
  • 22 Meyer D, Meyer F, Kretschmer T, Börm W. Translaminar screws of the axis–an alternative technique for rigid screw fixation in upper cervical spine instability. Neurosurg Rev 2012; 35 (02) 255-261
    Search in Google Scholar
  • 23 Chun DH, Yoon DH, Kim KN, Yi S, Shin DA, Ha Y. Biomechanical Comparison of Four Different Atlantoaxial Posterior Fixation Constructs in Adults: A Finite Element Study. Spine (Phila Pa 1976) 2018; 43 (15) E891-E897
    Search in Google Scholar
  • 24 Sai Kiran NA, Sivaraju L, Vidyasagar K. et al. Safety and Accuracy of Anatomic and Lateral Fluoroscopic-Guided Placement of C2 Pars/Pedicle Screws and C1 Lateral Mass Screws, and Freehand Placement of C2 Laminar Screws. World Neurosurg 2018; 118: e304-e315
    Search in Google Scholar
  • 25 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 (Phila Pa 1976) 2008; 33 (09) 960-965
    Search in Google Scholar
  • 26 Dobran M, Nasi D, Esposito DP, Iacoangeli M. Posterior Fixation with C1 Lateral Mass Screws and C2 Pars Screws for Type II Odontoid Fracture in the Elderly: Long-Term Follow-Up. World Neurosurg 2016; 96: 152-158
    Search in Google Scholar
  • 27 Chin KR, Mills MV, Seale J, Cumming V. Ideal starting point and trajectory for C2 pedicle screw placement: a 3D computed tomography analysis using perioperative measurements. Spine J 2014; 14 (04) 615-618
    Search in Google Scholar
  • 28 Dean CL, Lee MJ, Robbin M, Cassinelli EH. Correlation between computed tomography measurements and direct anatomic measurements of the axis for consideration of C2 laminar screw placement. Spine J 2009; 9 (03) 258-262
    Search in Google Scholar