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Fulltext Safety Issues and Neurological Improvement following C1-C2 Fusion using C1 Lateral Mass and C2 Pedicle Screw inAtlantoaxial Instability

Kwan, M.K., Chan, C.Y.W., Kwan, T.C.C., Saw, L.B., Gashi, Y.N.

Malays Orthop J, 2010;4(2):17-22.
MyJurnal

The evolution of instrumentation methods for C1-C2 fusion from the use of posterior wiring methods to transarticular screws and C1 lateral mass with C2 pedicle screw construct have improved fusion rates to almost 100%. However, the C1 lateral mass and C2 pedicle screw technique is technically demanding. This is a prospective review of a series of ten patients who was planned for C1-C2 fusion using C1 lateral mass and C2 pedicle screw technique between January 2007 and June 2009. The procedure was converted to occipital cervical fusion due to a fracture of a hypoplastic lateral mass-posterior arch complex in one patient and Gallie fusion due to a vertebral artery injury in another. Eight patients underwent the C1-C2 fusion using C1 lateral mass and C2 pedicle screw successfully without any complications. The union rate was 100% with an average union time of 5.3 months (range from 3 to 8 months). Postoperatively, the patients achieved an average of one Frankel grade neurological improvement. In conclusion, this technique provides an excellent union rate and good neurological recovery.

Matched MeSH terms: Atlanto-Axial Joint
Fulltext Surgical Morphometry of C1 and C2 Vertebrae: A Three-Dimensional Computed Tomography Analysis of 180 Chinese, Indian, and Malay Patients

Lee CK, Tan TS, Chan CYW, Kwan MK

Asian Spine J, 2017 Apr;11(2):181-189.
PMID: 28443161 DOI: 10.4184/asj.2017.11.2.181

STUDY DESIGN: Clinical imaging study.
PURPOSE: To study the surgical morphometry of C1 and C2 vertebrae in Chinese, Indian, and Malay patients.
OVERVIEW OF LITERATURE: C1 lateral mass and C2 pedicle screw fixation is gaining popularity. However, there is a lack of C1-C2 morphometric data for the Asian population.
METHODS: Computed tomography analysis of 180 subjects (60 subjects each belonging to Chinese, Indian, and Malay populations) using simulation software was performed. Length and angulations of C1 lateral mass (C1LM) and C2 pedicle (C2P) screws were assessed.
RESULTS: The predicted C1LM screw length was between 23.2 and 30.2 mm. The safe zone of trajectories was within 11.0°±7.7° laterally to 29.1°±6.2° medially in the axial plane and 37.0°±10.2° caudally to 20.9°±7.8° cephalically in the sagittal plane. The shortest and longest predicted C2P screw lengths were 22.1±2.8 mm and 28.5±3.2 mm, respectively. The safe trajectories were from 25.1° to 39.3° medially in the axial plane and 32.3° to 45.9° cephalically in the sagittal plane.
CONCLUSIONS: C1LM screw length was 23-30 mm with the axial safe zone from 11° laterally to 29° medially and sagittal safe zone at 21° cephalically. C2P screw length was 22-28 mm with axial safe zone from 26° to 40° medially and sagittal safe zone from 32° to 46° cephalically. These data serve as an important reference for Chinese, Indian, and Malay populations during C1-C2 instrumentation.

Matched MeSH terms: Atlanto-Axial Joint
Fulltext Median occipital condyle associated with atlantoaxial instability and myelopathy: a case report

Fadzil F

Med J Malaysia, 2011 Oct;66(4):365-6.
PMID: 22299561 MyJurnal

A Median Occipital Condyle is a rare occurrence. We have not found any clinical studies in the literature and myelopathy due to a median condyle has been reported once before. Myelopathy due to anomalies of the craniovertebral junction is rare in neurosurgical practice. We describe a case of a 72-year-old man presenting with progressive myelopathy related to a median occipital condyle located at the anterior foramen magnum region.

Matched MeSH terms: Atlanto-Axial Joint*
The effect of excision of the posterior arch of C1 on C1/C2 fusion using transarticular screws

Chang KC, Samartzis D, Fuego SM, Dhatt SS, Wong YW, Cheung WY, et al.

Bone Joint J, 2013 Jul;95-B(7):972-6.
PMID: 23814252 DOI: 10.1302/0301-620X.95B7.30598

Transarticular screw fixation with autograft is an established procedure for the surgical treatment of atlantoaxial instability. Removal of the posterior arch of C1 may affect the rate of fusion. This study assessed the rate of atlantoaxial fusion using transarticular screws with or without removal of the posterior arch of C1. We reviewed 30 consecutive patients who underwent atlantoaxial fusion with a minimum follow-up of two years. In 25 patients (group A) the posterior arch of C1 was not excised (group A) and in five it was (group B). Fusion was assessed on static and dynamic radiographs. In selected patients CT imaging was also used to assess fusion and the position of the screws. There were 15 men and 15 women with a mean age of 51.2 years (23 to 77) and a mean follow-up of 7.7 years (2 to 11.6). Stable union with a solid fusion or a stable fibrous union was achieved in 29 patients (97%). In Group A, 20 patients (80%) achieved a solid fusion, four (16%) a stable fibrous union and one (4%) a nonunion. In Group B, stable union was achieved in all patients, three having a solid fusion and two a stable fibrous union. There was no statistically significant difference between the status of fusion in the two groups. Complications were noted in 12 patients (40%); these were mainly related to the screws, and included malpositioning and breakage. The presence of an intact or removed posterior arch of C1 did not affect the rate of fusion in patients with atlantoaxial instability undergoing C1/C2 fusion using transarticular screws and autograft.

Matched MeSH terms: Atlanto-Axial Joint/abnormalities; Atlanto-Axial Joint/surgery
Erosive inflammatory pseudotumor of the odontoid process in association with Forestier's disease (diffuse idiopathic skeletal hyperostosis)

Mirzasadeghi A, Mokhtar SA, Azmi B, Haflah NM, Razak MA

Am J. Orthop., 2009 Feb;38(2):E41-4.
PMID: 19340387
Matched MeSH terms: Atlanto-Axial Joint/pathology; Atlanto-Axial Joint/radiography; Atlanto-Axial Joint/surgery
Fulltext Computed Tomographic Morphometric Analysis of C1 and C2 for Lamina Cross Screw Placement in Malay Ethnicity

Chan AKH, Yusof MI, Abdullah MS

Asian Spine J, 2021 Feb;15(1):1-8.
PMID: 32252193 DOI: 10.31616/asj.2019.0242

STUDY DESIGN: This is an observational study of computed tomography (CT) data.
PURPOSE: The C1 and C2 laminas in the Malaysian Malay population were analyzed for the feasibility of fitting 3.5-mm laminar screws in a cross configuration.
OVERVIEW OF LITERATURE: Morphometric analysis of the C1 and C2 laminas has been performed for various populations but not for the Malaysian Malay population.
METHODS: A total of 330 CT cervical images were measured to establish the bicortical diameter of the C1 and C2 laminas as well as their height and length. The C1 posterior tubercle bicortical diameter and height were also determined from these images. All parameters were measured up to 0.1 mm, and statistical analysis was performed using IBM SPSS Statistics ver. 24.0 (IBM Corp., Armonk, NY, USA). An independent t -test and the Pearson chi-square test were used to determine the mean difference and screw acceptance.
RESULTS: The means of the C1 lamina measurements were 5.79±1.19 mm in diameter, 9.76±1.51 mm in height, and 20.70±1.86 mm in length. The means of the measurements of the posterior tubercle were 7.20±1.88 mm in diameter and 10.51±1.68 mm in height. The means of the C2 lamina measurements were 5.74±1.31 mm in diameter, 11.76±1.69 mm in height, and 24.96±2.56 mm in length. Overall 65.5% of C1 and 80.3% of C2 laminas are able to accept 3.5-mm screws in a cross configuration. Screw acceptability is similar between the right and left sides (p >0.05). However, males have a higher screw acceptability compared with females (p <0.05), except for the C2 left lamina.
CONCLUSIONS: It is feasible to insert a 3.5-mm screw in a cross configuration in the C1 and C2 laminas of the Malaysian Malay population, especially in males. However, a CT scan should be performed prior to the operation to determine screw acceptability and to estimate screw sizes.

Matched MeSH terms: Atlanto-Axial Joint
Grisel's syndrome: a rare complication of tonsillectomy

Sia KJ, Tang IP, Kong CK, Nasriah A

J Laryngol Otol, 2012 May;126(5):529-31.
PMID: 22361094 DOI: 10.1017/S0022215112000175

To discuss the pathophysiology of atlanto-axial subluxation as a rare complication of tonsillectomy, and to discuss the important radiological findings for diagnosis and treatment planning.

Matched MeSH terms: Atlanto-Axial Joint*
Fulltext C1-C2 fusion with absence of C1 posterior arch and presence of C2 high-riding vertebral artery: Is it possible?

Wong TS, Abdul Rashid ML, Hasan MS, Chiu CK, Chan CYW, Kwan MK

J Orthop Surg (Hong Kong), 2019 4 9;27(2):2309499019840763.
PMID: 30955474 DOI: 10.1177/2309499019840763

The presence of anatomical anomalies such as absence of C1 posterior arch and presence of C2 high-riding vertebral artery may not allow a conventional C1-C2 fusion, and this patient will require occipitocervical fusion. A 62-year-old lady presented with cervical myelopathy. CT scan demonstrated an os odontoideum with C1-C2 dislocation. The posterior arch of atlas on right C1 vertebra was absent, and there was high-riding vertebral artery on left C2. MRI revealed severe cord compression with cord oedema. The chronic atlantoaxial dislocation was reduced successfully with skeletal traction. Hybrid C1-C2 fusion augmented with autogenous local bone graft with corticocancellous iliac crest bone graft was performed to avoid an unnecessary occipitocervical fusion. She was stable throughout surgery and discharged 6 days later. CT scan 6 months post-operation showed a solid posterior fusion mass. Hybrid C1-C2 fusion can be performed to avoid occipitocervical fusion despite presence of abnormal anatomy at C1 and C2 vertebrae.

Matched MeSH terms: Atlanto-Axial Joint/surgery
A minimally invasive endoscopic transnasal approach to the craniovertebral junction in the paediatric population

Tan SH, Ganesan D, Prepageran N, Waran V

Eur Arch Otorhinolaryngol, 2014 Nov;271(11):3101-5.
PMID: 24986428 DOI: 10.1007/s00405-014-3149-5
Matched MeSH terms: Atlanto-Axial Joint/surgery*
Endoscopic, endonasal decompression of spinal stenosis with myelopathy secondary to cranio-vertebral tuberculosis: two cases

Puraviappan P, Tang IP, Yong DJ, Prepageran N, Carrau RL, Kassam AB

J Laryngol Otol, 2010 Jul;124(7):816-9.
PMID: 20003599 DOI: 10.1017/S0022215109992271

Tuberculosis can cause extensive osseo-ligamentous destruction at the cranio-vertebral junction, leading to atlanto-axial instability and compression of vital cervico-medullary centres. This may manifest as quadriparesis, bulbar dysfunction and respiratory insufficiency.

Matched MeSH terms: Atlanto-Axial Joint/surgery
Fulltext Tophaceous gout causing atlanto-axial subluxation mimicking rheumatoid arthritis: a case report

Wazir NN, Moorthy V, Amalourde A, Lim HH

J Orthop Surg (Hong Kong), 2005 Aug;13(2):203-6.
PMID: 16131689 DOI: 10.1177/230949900501300220

This is a case report of an extremely rare condition of atlanto-axial subluxation secondary to gouty arthritis, which mimicked rheumatoid arthritis at presentation. Gouty arthritis involving the spine is a rare condition. We highlight a case of gouty arthritis involving the atlanto-axial joint resulting in joint instability, subluxation, and neurological deficit. A 66-year-old obese woman who had a polyarticular disease for the previous 3 years presented with neck pain and progressive neurology. A 2-stage procedure was performed: posterior decompression and occipitocervical fusion followed by further anterior trans-oral decompression. However, after an initial neurological improvement, she succumbed to aspirational pneumonia and septicaemia. Atlanto-axial subluxation caused by gouty arthritis can present in the same way as rheumatoid arthritis. Therefore, the possibility of this as a differential diagnosis should be kept in mind.

Matched MeSH terms: Atlanto-Axial Joint*