4-Point C2 Fixation for Occipitocervical Fusion: Technical Case Report. 2021

John K Houten, and Merritt D Kinon, and Gila R Weinstein
Department of Surgery, Maimonides Medical Center, Brooklyn, New York, USA; Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA. Electronic address: jkhmd@yahoo.com.

Occipitocervical fusion is an important surgical procedure to treat instability of the upper cervical and craniocervical junction. Fixation to the dense cortical bone of the occiput, contemporaneously typically accomplished with a plate and screws, is known to be strong and durable, but there are many competing methods used to secure an adequate number of fixation points of sufficient strength at the cervical end. Extension of hardware to the midcervical region to acquire additional fixation points, however, results in loss of subaxial motion segments and additional potential morbidity. The C2 vertebra is unique in that its morphology and dimensions permit fixation with longer screws than are typically possible to place in the midcervical lateral masses. Translaminar and pars screw techniques, both commonly used to achieve C2 fixation, are not mutually exclusive, as their respective trajectories are considerably different and engage different portions of the bony anatomy. We describe a novel, 4-point C2 fixation technique for OC fusion that may avoid the need to extend fusion to the subaxial spine. This technical note illustrates how 4-point C2 fixation can be employed in occiptocervical fusion. 4-point fixation of C2 combining translaminar and pars screw placement is technically feasible and may be a suitable strategy to spare subaxial motion segments in OC fusion procedures. Futher investigation may establish its applicability to additional surgical procedures.

UI MeSH Term Description Entries
D007593 Joint Instability Lack of stability of a joint or joint prosthesis. Hypermobility, Joint,Instability, Joint,Laxity, Joint,Hypermobilities, Joint,Instabilities, Joint,Joint Hypermobilities,Joint Hypermobility,Joint Instabilities,Joint Laxities,Joint Laxity,Laxities, Joint
D007796 Laminectomy A surgical procedure that entails removing all (laminectomy) or part (laminotomy) of selected vertebral lamina to relieve pressure on the SPINAL CORD and/or SPINAL NERVE ROOTS. Vertebral lamina is the thin flattened posterior wall of vertebral arch that forms the vertebral foramen through which pass the spinal cord and nerve roots. Laminotomy,Laminectomies,Laminotomies
D008297 Male Males
D009777 Occipital Bone Part of the back and base of the CRANIUM that encloses the FORAMEN MAGNUM. Basilar Bone,Basilar Bones,Bone, Basilar,Bone, Occipital,Bones, Basilar,Bones, Occipital,Occipital Bones
D009809 Odontoid Process The toothlike process on the upper surface of the axis, which articulates with the CERVICAL ATLAS above. Dens Axis,Axis, Dens,Odontoid Processes,Process, Odontoid,Processes, Odontoid
D001863 Bone Screws Specialized devices used in ORTHOPEDIC SURGERY to repair bone fractures. Bone Screw,Screw, Bone,Screws, Bone
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D001268 Atlanto-Axial Joint The joint involving the CERVICAL ATLAS and axis bones. Atlanto Axial Joint,Atlantoaxial Joint,Atlanto Axial Joints,Atlanto-Axial Joints,Atlantoaxial Joints,Joint, Atlanto Axial,Joint, Atlanto-Axial,Joint, Atlantoaxial,Joints, Atlanto Axial,Joints, Atlanto-Axial,Joints, Atlantoaxial
D001269 Atlanto-Occipital Joint The point of articulation between the OCCIPITAL BONE and the CERVICAL ATLAS. Atloido-Occipital Joint,Atlanto Occipital Joint,Atlanto-Occipital Joints,Atloido Occipital Joint,Atloido-Occipital Joints,Joint, Atlanto-Occipital,Joint, Atloido-Occipital,Joints, Atlanto-Occipital,Joints, Atloido-Occipital

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