Applied anatomy of screw placement via the posterior arch of the atlas and anatomy-based refinements of the technique
Tóm tắt
To present a method of posterior arch and lateral mass screw (PALMS) insertion and to prove its feasibility. Four formalin-fixed specimens and 40 macerated atlas vertebras were used to describe the relevant anatomy. The height of the posterior arch was measured on 42 consecutive patients using standard CT of the cervical spine. The operative technique and the special CT reconstructions used for preoperative planning are described. Eight patients underwent posterior fixation using this technique. We described the relevant anatomy and important anatomical landmarks of the posterior arch of the atlas. PALMS placement was modified according to these anatomical findings. Fifteen PALMSs were placed in eight patients using this technique without vascular or neural injury. It is feasible to place PALMS using the described technique. CT angiography is of crucial importance for preoperative planning using the described special reconstructions. The arch posterior to the lateral mass (APLM) is defined as the bone stock situated posterior to the lateral mass, respecting its convergence. The ideal entry point for a PALMS is on the APLM above the center of the converging lateral mass. A complete or incomplete ponticulus posticus and a retrotransverse foramen or groove can be used as an accessory landmark to refine the entry point.
Tài liệu tham khảo
Arnautović KI, al-Mefty O, Pait TG, Krisht AF, Husain MM (1997) The suboccipital cavernous sinus. J Neurosurg 86:252–262
Blagg SE, Don AS, Robertson PA (2009) Anatomic determination of optimal entry point and direction for C1 lateral mass screw placement. J Spinal Disord Tech 22:233–239
Bodon G, Patonay L, Baksa G, Olerud C (2014) Applied anatomy of a minimally invasive muscle-splitting approach to posterior C1–C2 fusion: an anatomical feasibility study. Surg Radiol Anat. doi:10.1007/s00276-014-1274-x
Christensen DM, Eastlack RK, Lynch JJ, Yaszemski MJ, Currier BL (2007) C1 anatomy and dimensions relative to lateral mass screw placement. Spine 32:844–848
Cramer GD, Darby SA (2013) Clinical anatomy of the spine, spinal cord, and ANS. Mosby
Currier BL, Todd LT, Maus TP, Fisher DR, Yaszemski MJ (2003) Anatomic relationship of the internal carotid artery to the C1 vertebra: a case report of cervical reconstruction for chordoma and pilot study to assess the risk of screw fixation of the atlas. Spine 28:E461–E467
Doherty BJ, Heggeness MH (1994) The quantitative anatomy of the atlas. Spine 19:2497–2500
Ebraheim NA, Misson JR, Xu R, Yeasting RA (2000) The optimal transarticular c1-2 screw length and the location of the hypoglossal nerve. Surg Neurol 53:208–210
Elliott RE, Tanweer O, Boah A, Morsi A, Ma T, Smith ML et al (2014) Atlantoaxial fusion with screw-rod constructs: meta-analysis and review of literature. World Neurosurg 81:411–421
Elliott RE, Tanweer O, Smith ML, Frempong-Boadu A (2013) Impact of starting point and bicortical purchase of C1 lateral mass screws on atlantoaxial fusion: meta-analysis and review of the literature. J Spinal Disord Tech 28:242–253. doi:10.1097/BSD.0b013e31828ffc97
Estillore RP, Buchowski JM, Minh DV, Park KW, Chang BS, Lee CK et al (2011) Risk of internal carotid artery injury during C1 screw placement: analysis of 160 computed tomography angiograms. Spine J 11:316–323
Fensky F, Kueny RA, Sellenschloh K, PüschelK Morlock MM, Rueger JM et al (2013) Biomechanical advantage of C1 pedicle screws over C1 lateral mass screws: a cadaveric study. Eur Spine J 23:724–731
Gebauer M, Barvencik F, Briem D, Kolb JP, Seitz S, Rueger JM et al (2009) Evaluation of anatomic landmarks and safe zones for screw placement in the atlas via the posterior arch. Eur Spine J 19:85–90
He B, Yan L, Xu Z, Chang Z, Liu T, Hao D (2013) Prospective, self-controlled, comparative study of trans-posterior arch lateral mass screw fixation and lateral mass screw fixation of the atlas in the treatment of atlantoaxial instability. J Spinal Disord Tech. doi:10.1097/BSD.0b013e3182a35572
Hong JT, Kim TH, Kim IS, Yang SH, Sung JH, Son BC et al (2010) The effect of patient age on the internal carotid artery location around the atlas. J Neurosurg Spine 12:613–618
Hong JT, Lee SW, Son BC, Sung JH, Kim IS, Park CK (2006) Hypoglossal nerve palsy after posterior screw placement on the C-1 lateral mass. Case report. J Neurosurg Spine 5:83–85
Kim JH, Kwak DS, Han SH, Cho SM, You SH, Kim MK (2013) Anatomic consideration of the C1 laminar arch for lateral mass screw fixation via C1 lateral lamina: a landmark between the lateral and posterior lamina of the C1. J Korean Neurosurg Soc 54:25–29
Lang J (2001) Skull base and related structures. Schattauer Verlag, Stuttgart
Le Minor JM (1997) The retrotransverse foramen of the human atlas vertebra. A distinctive variant within primates. Acta Anat 160:208–212
Lee MJ, Cassinelli E, Riew KD (2006) The feasibility of inserting atlas lateral mass screws via the posterior arch. Spine 31:2798–2801
Lee SH, Kim ES, Eoh W (2013) Modified C1 lateral mass screw insertion using a high entry point to avoid postoperative occipital neuralgia. J Clin Neurosci 20:162–167
Lin JM, Hipp JA, Reitman CA (2013) C1 lateral mass screw placement via the posterior arch: a technique comparison and anatomic analysis. Spine J 13:1549–1555
Ma XY, Yin QS, Wu ZH, Xia H, Liu JF, Xiang M et al (2009) C1 pedicle screws versus C1 lateral mass screws: comparisons of pullout strengths and biomechanical stabilities. Spine 34:371–377
Ma XY, Yin QS, Wu ZH, Xia H, Liu JF, Zhong SZ (2005) Anatomic considerations for the pedicle screw placement in the first cervical vertebra. Spine 30:1519–1523
Murakami S, Mizutani J, Fukuoka M, Kato K, Sekiya I, Okamoto H et al (2008) Relationship between screw trajectory of C1 lateral mass screw and internal carotid artery. Spine 33:2581–2585
Qian LX, Hao DJ, He BR, Jiang YH (2013) Morphology of the atlas pedicle revisited: a morphometric CT-based study on 120 patients. Eur Spine J 22:1142–1146
Resnick DK, Lapsiwala S, Trost GR (2002) Anatomic suitability of the C1–C2 complex for pedicle screw fixation. Spine 27:1494–1498
Salunke P, Futane S, Sahoo SH, Ghuman MS, Khandelwal N (2014) Operative nuances to safeguard anomalous vertebral artery without compromising the surgery for congenital atlantoaxial dislocation: untying a tough knot between vessel and bone. J Neurosurg Spine 20:5–10
Schuster R, Waxman K, Sanchez B, Becerra S, Chung R, Conner S et al (2005) Magnetic resonance imaging is not needed to clear cervical spines in blunt trauma patients with normal computed tomographic results and no motor deficits. Arch Surg 140:762–766
Senoglu M, Gümüşalan Y, Yüksel KZ, Uzel M, Celik M, Ozbag D (2006) The effect of posterior bridging of C-1 on craniovertebral junction surgery. J Neurosurg Spine 5:50–52
Suchomel P, Choutka O (2010) Reconstruction of upper cervical spine and craniovertebral junction. Springer, Berlin, Heidelberg. doi:10.1007/978-3-642-13158-5
Tan M, Wang H, Wang Y, Zhang G, Yi P, Li Z et al (2003) Morphometric evaluation of screw fixation in atlas via posterior arch and lateral mass. Spine 28:888–895
Yamaguchi S, Eguchi K, Kiura Y, Takeda M, Kurisu K (2008) Posterolateral protrusion of the vertebral artery over the posterior arch of the atlas: quantitative anatomical study using three-dimensional computed tomography angiography. J Neurosurg Spine 9:167–174
Zarro CM, Ludwig SC, Hsieh AH, Seal CN, Gelb DE (2013) Biomechanical comparison of the pullout strengths of C1 lateral mass screws and C1 posterior arch screws. Spine J 13:1892–1896