Seven Years of Experience With C2 Translaminar Screw Fixation: Clinical Series and Review of the Literature

• Published in: Neurosurgery Vol. 68; no. 6; pp. 1491 - 1499
• Main Authors: Dorward, Ian G., Wright, Neill M.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Oxford University Press 01.06.2011; Lippincott Williams & Wilkins; Wolters Kluwer Health, Inc
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Biomechanics; Bone Screws - adverse effects; Cervical Vertebrae - surgery; Female; Humans; Male; Medical sciences; Middle Aged; Neurosurgery; Postoperative Complications - epidemiology; Spinal Fusion - instrumentation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tomography; Crossing laminar; C2 fixation; Axis fixation; Translaminar; Laminar screws; Nervous system diseases; Fixation; Screw; Surgery
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1227/NEU.0b013e318212a4d7

Abstract BACKGROUND: C2 translaminar screws offer biomechanical stability similar to that of other C2 fixation methods but with minimal risk to neural and vascular structures. OBJECTIVE: To report our experience with the technique since 2002 and to review the pertinent literature to advance the understanding of C2 translaminar screw fixation. METHODS: Fifty-two consecutive adult patients with disorders requiring axis stabilization were treated with C2 translaminar screws by a single surgeon. All patients underwent preoperative computed tomography scans to confirm the feasibility of screw placement. Patients were followed up with serial flexion/extension radiographs and/or computed tomography scans. RESULTS: The average age in our series was 58.1 years. One hundred three C2 translaminar screws were placed (average length, 28.9 mm). No vascular or neurological injuries occurred. Of 41 patients with sufficient follow-up (average, 13.3 months) to evaluate fusion, 1 instrumentation failure/pseudoarthrosis was observed. Five patients (average age, 78.7 years) died of complications related to medical comorbidities. In the literature, 169 cases of C2 translaminar fixation have been reported, with a fusion rate of 95.3% and no vertebral artery injuries. In biomechanical studies, C2 translaminar screws perform similarly to C2 pedicle screws and may outperform C2 pars screws in intact spine models. With disrupted atlantoaxial ligaments, constructs with C2 translaminar screws may not resist lateral bending as well as those with other screws, although they have more stability than uninstrumented, intact spines. CONCLUSION: This study reports 103 C2 translaminar screws, the largest single-surgeon series to date. C2 translaminar screws are a technically feasible, low-risk option for C2 fixation, with a 97.6% fusion rate in this series.