This video explains the surgical technique used for a c1c2 posterior fusion. Due to increased neck pain, radiographs were taken on the fourth postoperative day, and showed displacement. Both techniques are quite complex and require an indepth knowledge of the surgical anatomy to ensure a good technical outcome. Proximal laminar hooks are associated with decreased rate of proximal junctional kyphosis in spinal fusion for adult spinal deformity compared to pedicle screw fixation. Outcomes of c1 and c2 posterior screw fixation for upper cervical spine fusion. The same can be said of poor surgical hemostasis because surgical bleeding will persist until the cause is found and repaired. C12 dorsal internal fixation and fusion harmsgoel technique. C1c2 posterior cervical fusion neurosurgery oxford.
Posterior c1 c2 fusion using either harmss or magerls technique represent the most important advancement in upper cervical posterior fusion surgery. Spinal fusion may be recommended when the natural disc space has decreased or the spine is unstable. I knew it would be difficult, but i had no idea the amount of pain and stiffness i would have. With the use of intraoperative spinal navigation, we demonstrate a modified c1c2 posterior fusion technique, rendering accuracy, feasibility, and overall safety. The two most common types of c1c2 fusion that i see in patients i consult on are posterior screw fixation magerl technique or c1c1 transarticular screws. These suboptimal results and surgical complications prompted the development of novel techniques to replace the sublaminar wiring at c2 with a. This technique can be incorporated as part of fusions to the occiput andor the. They are hoping to go in through the front, however we are. A modified posterior c1c2 fusion technique for the. C1c2 fusion harmsgoel technique surgical video this is a surgical technique video demonstrating posterior atlantoaxial fusion c1 lateral mass c2 pedicle screw fixation technique as described by dr. C1 lateral mass and c1c2 transarticular polyaxial screw rod fixation.
Anterior approach with aggressive kyphosis correction. Posterior approach to the c1c2 joints springerlink. Technique for surgical treatment of adolescent idiopathic scoliosis chapter 97. C12 posterior arthrodesis technique with a left segmental and right. And just to make sure you had an occiput to c2 fusion, done through the back of the headneck, correct. Joel franck specializes in a neck surgery known as cervical fusion and has developed an innovative, highly effective, method of c1c2 fusion, requiring only a brief recovery at the surgery center then a premium hotel stay. Recently, harms described a new technique using polyaxial screws in the c1 lateral. Safety issues and neurological improvement following c1c2. C1c2 fusion indication, techniques to fix it and general complications.
Excellent surgical hemostasis can make much of intraoperative blood conservation moot. Anterior transarticular screw fixation effectively stabilizes c1c2. Precise indications for situations when the use of instrumentation is imperative. Technique for surgical treatment of adolescent idiopathic scoliosis transfeldt. Fusion is a surgical technique in which one or more of the vertebrae of the cervical spine are united together fused so that motion no longer occurs between them. Meticulous surgical technique, judicious use of bipolar coagulation, and use of an operating microscope when necessary permit all posterior cervical procedures to be performed safely in prone position. C12 posterior arthrodesis technique with a left segmental. Several surgical techniques for c1c2 stabilization and fusion have been described in the literature 4, 21, 23, 25, 36, 37. C2 dissection the entire spinous process, lamina, pars, and pedicle of c2 needs to be exposed. Both goel and magerl techniques of c1c2 posterior fusion techniques were. I wont lie, its been hard, but i seem to be getting a tiny bit better each day.
Here, we present a novel technique utilizing a polyaxial screw rod system and a. This means he cannot drive, and even walking along a sidewalk could be dicey he cannot turn his head to see beside or behind himself. Ct scan can be useful in guiding surgical technique. The ct of the cervical spine 12 months postoperatively showed rigid bony c1c2 fusion, without recurrence of stroke. The fractured vertebrae are fixed together with wires, plates, and screws. Magerls technique consists of an in situ c1c2 transarticular. It not only highlights the newest devices, but also the clinical guidelines needed to choose and apply the best implant for any surgical situation. However, most fusion surgeries in the cervical spine occur in one or more of the lower levels c4 through c7. Sunil nadkarni is a very skilled cervical spine specialist for stabilization or fusion of the c1 c2 joints of the cervical spine. Posterior atlantoaxial fusion using c1 lateral mass and c2 pedicle by polyaxial screw in atlantoaxial instability. Surgical technique is the most important component of blood conservation in pediatric cardiac surgery.
This comprehensive, uptodate textbook of modern cervical spine surgery. What are the surgical options for c12 fixation fusion in. Posterior atlantoaxial fusion using a c2 transverse. Posterior fusion of the first and second cervical vertebrae c1c2 is a wellknown technique for the treatment of traumatic, posttraumatic and congenital instability of c1c2 junction. Vaccaro and eli baron, offers a highly visual, stepbystep approach to the latest techniques in the field. New technique for c1c2 fixation surgical neurology. As such, a one or twolevel fusion in the lower cervical spine has little impact on the necks overall range of.
From an historical perspective, many sublaminar wiring techniques have been developed and are still in use. Posterior occipital cervical fixation spineuniverse. Surgical technique an overview sciencedirect topics. This surgery is usually performed at the back of the cervical spine. With the addition of the digital format that is both intuitive and an expansion of the print format, this book on the cervical spine. Cervical spine anatomy approaches to the upper cervical spine anterior surgical approach to the cervical spine posterior surgical approach to. Thorough updates keep you current with recent changes in spine surgery, and new contributors bring a fresh perspective to this rapidlychanging specialty. He will be in a hard collar for six weeks to three months unable to move his head. In this procedure, a screw is placed from the back of the neck into the c2 bone, through the c1c2 joint, and into the c1 bone. Several techniques can be utilized to provide for the adequate. If the posterior clamp construct loosens before bony fusion is achieved, then further surgical intervention will be required. The c1 lateral mass screw with c1c2 transarticular screw is a novel posterior atlantoaxial fixation technique for atlantoaxial instability and is based on established posterior atlantoaxial fixation techniques. C1c2 cervical transarticular screw fixation silber c1c2 anterior plate fixation silber.
Posterior atlantoaxial fusion using c1 lateral mass and c2 pedicle by polyaxial. The concept of fusion is similar to that of welding in industry. Pdf c1c2 arthrodesis is a surgical challenge due to the proximity of. The specific procedure im seeing more of is called transarticular c1c2 screw fixation. The surgical repair of atlantoaxial instabilities aai presents complex and unique challenges, originating from abnormalities andor trauma within the junction regions of the c1c2 atlasaxis, to surgeons. The neck is kept neutral and the head is placed in the military tuck position. Along with an allinclusive list of the spinal instruments available today, the book offers direct comparisons of each system to help make an informed and confident selection. The goal of lumbar fusion is to create a solid bridge of bone between two or more vertebrae. Cervical spinal fusion surgery, however does not weld the vertebrae together immediately during surgery. Postoperatively, the patient was managed in a hard collar. C12 fusion through the anterior approach for failed odontoid screw fixation 63 volume 22, june 2012 purchase was felt, and intraoperative rays showed good x position figures 2,3. In the c1c2 screw fixation, a single screw is placed across the joint as shown to the left. When this region is destabilized, surgical fusion becomes of key importance in order to prevent spinal cord injury. A possible novel technique for intraoperative imaging of the vertebral artery.
This book will enable surgeons to further develop their skills and improve outcomes when performing modern cervical spine surgery. Os odontoideum n 2, atlantoaxial instability after c3c5 fusion n 1, and. This entails a higher potential rate of neurological or dural injury than does the single cable passage under the posterior c1 arch for the gallie technique. C1c2 arthrodesis may be performed using a number of methods. Pdf epub surgical approaches to the spine pp 224236 cite as. Apart from this, both the techniques have shown to result in fusion rates nearing 100%, even without postoperative immobilization 46. Detailed step by step description of posterior c1c2 fusion for c1c2 dislocation located in our module on occipitocervical trauma with illustrations including patient positioning, approach and aftercare. Surgical technique guide oct spinal system not intended for distribution in the us.
In this study we discuss a new approach to c1c2 stabilization using transarticular screws placed anteriorly. Have you had followup with xrays or ct scan to show that the surgical fusion had healed well. How much neck mobility is lost after fusion surgery. Craig humphreys jan 10, 2019 if youre a just the facts kind of person, heres a fact you might be interested in. To describe the anterior approach for cervical discectomy and fusion acdf at c2c3 level and evaluate its suitability for treatment of instability and degenerative disease in this region. I just had my c1 c2 fusion about 5 days ago and im finally home from the hospital recovering. We introduced a novel c1c2 transarticular screwplacement technique in which the trajectory went through the ipsilateral va foramen due to. It describes the standard and advanced techniques recommended by the cervical spine research society european csrse. Spinal instability and spinal fusion surgery treatment. C2 reduces the number of vertebral segments that are necessary to incorporate into the fusion construct while providing superior immobilization and resistance to fatigue and vertical settling compared with sublaminar methods. These views of the axis are part of complete series which accurately describe the historical evolution of fixation techniques for the cervical vertebrae c1 and c2. C12 fusion through the anterior approach for failed. Abstract the evolution of instrumentation methods for c1c2 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%.
Atlantoaxial fusion using anterior transarticular screw. We developed a unique setup for testing c1c2 fixation constructs. Traditionally, the posterior wiring techniques popularized by gallie and brooks and jenkins have been the most common means of achieving fusion, but in recent years, a variety of other techniques have become available, including the use of interlaminar clamps and transarticular screw fixation. New technique for c1c2 fixation surgical neurology international. C1c2 posterior arthrodesis, novel technique, segmental fixation. The patient is positioned prone using a mayfield head holder omi, inc, cincinnati, oh. C1 c2 stabilisation or fusion best skilled surgeon. I am a 34 year old female and i just found out that i will have to have neck surgery due to my neck closing in on my spinal cord. They will have to fuse c1c7, has anyone had this problem or had this surgery done. We conclude that c1 lateral mass and c1c2 transarticular polyaxial screw rod fixation is a novel and effective surgical technique to achieve immediate rigid immobilization of the c1c2 motion segment. Spinal fusion is a technique used to stabilize the spinal bones or vertebrae. The goal is to stabilize the c1 on the c2 bone to take the place of the damaged alar ligaments.
It is always interesting to learn screw placement in sub axial cervical spine by observing a video clip. A case is presented in this for easier understanding. After having a c1c2 posterior fusion in 1994 at the age of 31, i am now being told that i need a c2t2 posterior fusion due to a herniated nucleus polposis at c3c4 and minor problems at all levels due a domino effect that has occurred over the last 20 years. Safety issues and neurological improvement following c1. C1c2 cervical transarticular screw fixation chapter 11. Get free shipping on spinal instrumentation surgical techniques isbn. However, the c1 lateral mass and c2 pedicle screw technique is technically demanding. Harms and melcher further popularized the technique of posterior c1 c2 fusion with c1 lateral mass screw and c2 pedicle screw 10 11. Here, we present a novel technique utilizing a polyaxial screw rod system. Demographic data, clinical indications, surgical technique, complications, and immediate results were evaluated. Cervical spinal fusion posterior instrumented fusion. This technique can be useful in cases when the c1 posterior arch is fractured or a c1 laminectomy is required.
Posterior atlantoaxial fusion using c1 lateral mass and c2. Outcomes of c1 and c2 posterior screw fixation for upper. In the sonntag technique, a sublaminar cable is passed under the posterior c1 arch from inferior to superior. Focusing solely on mustknow procedures, operative techniques.
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