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Novel Technique for C1?2 Interlaminar Arthrodesis Utilizing a Modified Sonntag Loop-Suture Graft With Posterior C1?2 Fixation

Neurospine 2020년 17권 3호 p.659 ~ 665
Koffie Robert M., Larsen Alexandra M. Giantini, Grannan Benjamin L., Hadzipasic Muhamed, Yanamadala Vijay, Van Beaver Laura, Shankar Ganesh M., Shin John H.,
소속 상세정보
 ( Koffie Robert M. ) - Harvard Medical School Massachusetts General Hospital Department of Neurosurgery
 ( Larsen Alexandra M. Giantini ) - Harvard Medical School Massachusetts General Hospital Department of Neurosurgery
 ( Grannan Benjamin L. ) - Harvard Medical School Massachusetts General Hospital Department of Neurosurgery
 ( Hadzipasic Muhamed ) - Harvard Medical School Massachusetts General Hospital Department of Neurosurgery
 ( Yanamadala Vijay ) - Harvard Medical School Massachusetts General Hospital Department of Neurosurgery
 ( Van Beaver Laura ) - Harvard Medical School Massachusetts General Hospital Department of Neurosurgery
 ( Shankar Ganesh M. ) - Harvard Medical School Massachusetts General Hospital Department of Neurosurgery
 ( Shin John H. ) - Harvard Medical School Massachusetts General Hospital Department of Neurosurgery

Abstract


Objective: Conventional techniques for atlantoaxial fixation and fusion typically pass cables or wires underneath C1 lamina to secure the bone graft between the posterior elements of C1?2, which leads to complications such as cerebrospinal fluid (CSF) leak and neurological injury. With the evolution of fixation hardware, we propose a novel C1?2 fixation technique that avoids the morbidity and complications associated with sublaminar cables and wires.

Methods: This technique entails wedging and anchoring a structural iliac crest graft between C1 and C2 for interlaminar arthrodesis and securing it using a 0-Prolene suture at the time of C1 lateral mass and C2 pars interarticularis screw fixation.

Results: We identified 32 patients who underwent surgery for atlantoaxial with our technique. A 60% improvement in pain-related disability from preoperative baseline was demonstrated by Neck Disability Index (p<0.001). There were no neurologic deficits. Complications included 2 patients CSF leaks related to presenting trauma, 1 patient with surgical site infection, and 1 patient with transient dysphagia. The rate of radiographic atlantoaxial fusion was 96.8% at 6 months, with no evidence of instrumentation failure, graft dislodgement, or graft related complications.

Conclusion: We demonstrate a novel technique for C1?2 arthrodesis that is a safe and effective option for atlantoaxial fusion.

키워드

Arthrodesis; Atlantoaxial instability; Fusion; Interlaminar bone graft; Sublaminar

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