C2 translaminar screw as an alternative option for C2 pedicle screw in subaxial cervical fusion
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easy method for proximal anchoring in cervical fusion surgery
C2 translaminar screw as an alternative option for C2 pedicle screw in subaxial cervical fusion
- 1. C2 translaminar screws instead of C2 pedicle screws in subaxial cervical spine fusion by Amer Alkot Mostafa Elsadek Lecturer of orthopedics Al-Azhar university Assiut 2
- 2. 1
- 4. -A broad range of disorders may be addressed via posterior cervical spine approach. -It is easy to consider the approach in two distinct anatomic regions,
- 5. -the occipitocervical junction (including the occiput to C2) -the subaxial cervical spine (C3 to C7).
- 6. despite the approach to both regions is similar, the anatomy, function, and associated pathologic features of these two segments are different.
- 7. At the occipitocervical and atlantoaxial articulations many techniques of fusion were discussed including -Wiring and cables techniques -Goel-Harmes technique -Trans articular screws -Wright technique but in the subaxial region a little technique was discussed (facet screws wires and lateral mass screws)
- 8. C2 translaminar screws (Wright's technique) since first described in 2002 by Neill Wright had gained popularity regarding its use in Occipito-Cervical and atlantoaxial fusion however little data about its use as proximal anchoring point in subaxial cervical spine fusion
- 11. The use of C2 as the proximal anchoring point for the subaxial construct is common as it provides the strongest anchoring point through -pedicles -pars -lamina the 1st and 2nd options carry the risk of vertebral artery injury in addition to being. -difficult -may not be suitable
- 12. Popular misconception that pedicle screws are safe, anatomic studies revealed that 8-9% are not candidates for pedicle screws and 4-6 %are not candidates for pars screws (Resnik spine 2000)
- 13. C2 Translaminar screws can provide the same quality of fixation as C2 pedicle screws with nearly no complications (J Spinal Disord Tech Volume 17, April 2004)
- 14. indication for subaxial spine fusion include to stabilize non stable spine e.g. post traumatic to align a deformed cervical spine e.g. cervical kyphosis to decompress a stenotic spine e.g. ossified PLL to excise a pathologic vertebra e.g. tumor All can utilize C2 translaminar provided that -Not to be removed -Not fractured
- 15. Study design Prospective Comparative study of 20 patients in need for posterior subaxial fusion divided into 2 groups the first 10 patients with C2 pars or pedicle screws as proximal anchoring point and another 10 patients with C2 translaminar screws as proximal anchoring point. Standard C2 to T1 fusion was done in both group
- 18. Objectives of the study Analysis and assessment of the validity of C2 translaminar screws as proximal anchoring point in subaxial spine fusion and comparing it with the C2 pedicle screws used for the same purpose. Points for comparison include -Surgical time -Complications -Use of C-arm -Incidence of pulling out -Bony fusion
- 21. Results (Continuous study.) Our early results Surgical time, need for frequent C-arm, operative and post-operative complications are better with C2translaminar group.
- 22. Results (Continuous study.) Our early results blood loss, early metal failure rate of infection are comparable in both groups.
- 23. Take home message C2 translaminar screws seems to be efficient and easy option for proximal anchoring in subaxial cervical spine fusion
- 24. Amer Alkot