Ct scan can be useful in guiding surgical technique. Surgical methods used in the c1c2 vertebral levels include. Posterior spinal fixation of the c1c2 articulation in the presence of instability has been well described in. The disadvantages of the brooksjenkins fusion technique include the need for passage of bilateral sublaminar cables beneath both c1 and c2. I had a c1 c2 fusion about a week and a half ago and its been really hard recovering. Installing spacers enabled reclination of the sterno cleido mastoid, homohyoid muscles and nervous vascular package outside and inside aerodigestive tracts exposing the anterior longitudinal ligament. 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. Spine surgery, 2nd edition delivers stepbystep, multimedia guidance to help you master the mustknow techniques in this field.
C1c2 rotary subluxation following posterior stabilization. Anterior screw fixation was the most frequent surgical technique 75%, and a rigid neck brace was the most frequent type of conservative external immobilization 65%. After exposing the surgical site, bilateral lateral mass screws are placed in c1 and bilateral pedicle screws are placed in c2. When the fusion takes place, some surgeons ablate rough up the c12 facets to allow fusion to take place there. Stenosis or narrowing of the foramen of the c1c2 vertebrae damages blood vessels andor spinal nerves. Posterior atlantoaxial fusion using c1 lateral mass and c2 pedicle by polyaxial. Complications of upper cervical spine trauma in elderly subjects. The unique minimally invasive high tech cervical fusion techniques developed by dr. Safety issues and neurological improvement following c1c2. The success of a c1c2 posterior fusion rests on appropriate indications and surgical techniques. C1c2 fusion cervical fusion c1c2 instability c1c2 screws cervical months. Copy of 1 level c1c2 posterior cervical fusion this stock medical illustration depicts a c1 laminotomy. C1c2 posterior fusion surgery print quality instant. C1 c2 cervical fusion recovering i knew it would be difficult, but i had no idea the amount of pain and stiffness i would have.
C1c2 is a wellknown technique for the treatment of traumatic, posttraumatic and congenital instability of c1c2 junction. C1 2 dorsal internal fixation and fusion harmsgoel technique introduction c1 lateral mass screws and c2 pedicle screws is a technique originally described by goel 1994 and later popularized by harms and melcher 2001. Pain in c2, c3, and c4 possible fusion, anybody else with pain here. This test will determine if you are a candidate for the c1c2 fusion. The worst is trying to sleep at night because laying down makes it.
Im wondering if this was discovered earlier, what other interventions may have been a possibility. Technique for surgical treatment of adolescent idiopathic scoliosis chapter 97. This method achieved a lower fusion rate than other fusion methods in the general population. Taghizadeh2 1neurosugery department, shahid beheshti university of medical sciences, tehran, iran. Pre and postoperative threedimensional computed tomographic ct scans were. Posterior atlantoaxial fusion using c1 lateral mass and c2. Surgical technique guide oct spinal system not intended for distribution in the us.
Rigid fixation improves outcomes of spinal fusion for c1c2. A variety of techniques have been successively recommended to reduce anatomic risk and improve results in terms of biomechanical stability and fusion rates. The goal of lumbar fusion is to create a solid bridge of bone between two or more vertebrae. Neck surgery digital motion xray, dmx joel franck, md. Application of a 3d custom printed patient specific spinal implant for c12 arthrodesis kevin phan1,2, alessandro sgro1. The frequency of cervical spine trauma in elderly patients is increasing with most injuries occurring in the upper cervical spine. Spinal instability and spinal fusion surgery treatment. The posterior arch of c1, lateral masses of c2, and c1 2 joints are decorticated. Posterior cervical fusion using songer cable, corticocancellous bone chip and grafton placement.
Once a fracture is discovered the approach usually is a surgical fusion in order to stabilize the spine at this level and prevent any major. A modified posterior c1c2 fusion technique for the. While neck fusion has a good record of eliminating or reducing neckrelated arm pain, tingling, and weakness, many patients want to know how much neck mobility might be lost when one or more mobile joints in the neck are fused solidand whether that can impact quality of life. See potential risks and complications of acdf surgery.
Destabilization of this joint is multifactorial and can lead to pathologic motion with neurologic sequelae. Feb 19, 2018 the disadvantages of the brooksjenkins fusion technique include the need for passage of bilateral sublaminar cables beneath both c1 and c2. Indications, technique, complications and outcomes in a prospective 26 case series. As such, a one or twolevel fusion in the lower cervical spine has little impact on the necks overall range of. C1c2 fusion used polyaxial screws with a diameter of 3. C1c2 posterior fusion surgery certified medical illustrations. The concept of fusion is similar to that of welding in industry. That may not be possible at the three month healing stage. These fractures are associated with a risk of sometimes lifethreatening complications, although very few studies have specifically analyzed this. The dorsal root ganglion of c2 lies just posterior to the starting point of the c1 screw and must be gently retracted caudally for adequate exposure figure 114, a. To report the surgical technique and preliminary clinical results for the treatment of basilar invagination bi with atlantoaxial dislocation aad by posterior c1c2 pedicle screw and rod instrument. Pre and postoperative threedimensional computed tomographic ct scans were performed.
Cervical spinal fusion surgery, however does not weld the vertebrae together immediately during surgery. 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. Jun 18, 2014 to report the surgical technique and preliminary clinical results for the treatment of basilar invagination bi with atlantoaxial dislocation aad by posterior c1c2 pedicle screw and rod instrument. Distraction arthrodesis of the c1c2 facet joint with preser.
The posterior arch of c1, lateral masses of c2, and c12 joints are decorticated. Complications of upper cervical spine trauma in elderly. Indications, technique, complications and outcomes in a prospective 26case series. All patients were operated on by the same surgeon cb, to reduce variability related to surgical technique. Application of a 3d custom printed patient specific spinal. The disadvantage is that the spinal cord cannot be decompressed at the same time because the piece of bone. Methods of posterior c1c2 fixation posterior c1c2 fusion with interlaminar clamps. The starting point for the c1 screw is at the midpoint of the inferior portion of the c1 lateral mass at its. Spinal fusion remains a common intervention for a range of spinal. Outcomes of c1 and c2 posterior screw fixation for upper cervical spine fusion.
They did a bone graft from my hip and when i turn my neck it makes a grinding noise. If the pain is bad enough, a fusion will need to be considered. Surgical procedure images purchased from this web site may only be used to support one legal case per license. The content on this site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. This stock medical illustration depicts a c1 laminotomy. Apr 23, 2009 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.
Posterior c1c2 fusion using either harmss or magerls technique represent the most important advancement in upper cervical posterior fusion surgery. For a more detailed clinical description of this process, it is highly recommended that the reader accesses the following. Copy of 1 level c1c2 posterior cervical fusion medical. The harms technique of stabilizing c1c2 using fixation of the c1 lateral mass and the c2 pedicle with polyaxial screws and rods is a further option when utilizing the posterior approach. C1c2 arthrodesis is a surgical challenge due to the proximity of neurovascular structures vertebral arteries and spinal cord and the wide range of motion of the joint, hampering bone fusion. The magerl technique, known as c1c2 transarticular screw fixation with posterior wiring, developed for higher fusion rate.
If you had a fusion of c12, reversing it is a problem. If the posterior clamp construct loosens before bony fusion is achieved, then further surgical intervention will be required. 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. C1 c2 fusion cervical fusion c1 c2 instability c1 c2 screws cervical months. How much neck mobility is lost after fusion surgery. 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. This surgery is usually performed at the back of the cervical spine.
The surgical treatment principles of atlantoaxial instability. He will be in a hard collar for six weeks to three months unable to move his head. The exhibit illustrates posterior fusion surgery to stabilize cervical vertebrae c1 and c2. Diagnostics to find out if you are a candidate for the c1c2 fusion neck surgery, surgical treatment of postcervical whiplash or cervical trauma, dr franck. I wont lie, its been hard, but i seem to be getting a tiny bit. It goes to my forehead up around the top of my head. To increase the fusion rate, magerl introduced the transarticular screw fixation c1c2 in 1987 harms and melcher, spine 26. Outcomes of c1 and c2 posterior screw fixation for upper. Spinal fusion is a technique used to stabilize the spinal bones or vertebrae.
I had a c1 c2 fusion done 6 weeks ago and just started to get out of the hard collar at home. Distraction arthrodesis of the c1c2 facet joint with. A novel surgical technique of distraction arthrodesis of the c1c2 facet joint with preservation of the c2 roots for the management of intractable occipital neuralgia caused by c2 root compression was designed. Posterior c1c2 fusion with polyaxial screw and rod fixation jurgen harms, md, robert p. Rigid fixation improves outcomes of spinal fusion for c1 c2 instability in children with skeletal dysplasias.
Reversal of c1 c2 posterior fusion 4 screws, 2 rods. Harms and melcher further popularized the technique of posterior c1 c2 fusion with c1 lateral mass screw and c2 pedicle screw 10 11. A patient, with mobile aad, underwent brooks c1c2 fusion while the other, with fixed aad, underwent transoral decompression followed by jains occipitocervical fusion. Most of my problems are with my headaches more than the neck. Neurologic symptoms can occur when the spinal cord or adjacent nerve roots are involved. If the fracture does not heal and cannot be realigned at this point, you will need a fusion of this.
The other option is to have a skull base surgical specialist see if they can loosen this displaced fracture and realign it. Cervical spinal fusion posterior instrumented fusion. Between july 2012 and august 20, 33 patients who had bi with aad underwent surgery at our institution. From an historical perspective, many sublaminar wiring techniques have been developed and are still in use. I had a xray at 4 weeks and it showed the fusion was taking place but now i am nervous that i have screwed it up somehow by turning my neck to soon. However, most fusion surgeries in the cervical spine occur in one or more of the lower levels c4 through c7. This document was downloaded for personal use only. C12 dorsal internal fixation and fusion harmsgoel technique. The posterior arch of c1 and the c12 facet joint are key anatomic landmarks for the placement of c1 lateral mass screws. These advancements of technique have allowed for better fusion rates with increasing stabilizacase reportc1c2 fusion.
It resulted in significantly better results in alleviating occipital neuralgia than conventional c1c2 fusion with c2 root transection. C1 c2 arthrodesis is a surgical challenge due to the proximity of neurovascular structures vertebral arteries and spinal cord and the wide range of motion of the joint, hampering bone fusion. I knew it would be difficult, but i had no idea the amount of pain and stiffness i would have. The magerl technique, known as c1 c2 transarticular screw fixation with posterior wiring, developed for higher fusion rate. Rigid fixation improves outcomes of spinal fusion for c1c2 instability in children with skeletal dysplasias. I wont lie, its been hard, but i seem to be getting a tiny bit better each day. The posterior arch of c1 and the c1 2 facet joint are key anatomic landmarks for the placement of c1 lateral mass screws. The authors report a rare complication of c1c2 rotary subluxation in two children following posterior stabilization for congenital atlantoaxial dislocation aad. Mar 06, 2020 in the past 3 decades, increased understanding of spinal biomechanics, proliferation of sophisticated spinal instrumentation devices, advances in bone fusion techniques, refinement of anterior approaches to the spine, and development of microsurgical and minimally invasive methods have made it possible to stabilize every segment of the spine. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease. Following surgical exposure of the posterior elements at c1c2 using a standardised posterior approach technique and subperiosteal muscle dissection, the custom 3dp drill guide was used to place 44 mm trans articular screws through the fixation device which was onlaid over the c2 spinous process and lamina see figure 1 10. 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 with 23 hour nursing care immediately postop. Posterior atlantoaxial fusion using c1 lateral mass and c2 pedicle by polyaxial screw in atlantoaxial instability.
Spinal fusion may be recommended when the natural disc space has decreased or the spine is unstable. Case reports on wiregraft fusion complications due to c1 posterior arch fracture were described in ra patients. Part of the popular and practical operative techniques series, this orthopaedics reference focuses on individual procedures, each. I am still in very much pain and it so hard to keep each day going.
C1c2 cervical transarticular screw fixation chapter 11. C1c2 arthrodesis is a surgical challenge due to the proximity of neurovascular structures vertebral arteries and spinal cord and the wide. Posterior atlantoaxial fusion using c1 lateral mass and c2 pedicle by polyaxial screw in atlantoaxial instability o. Rigid fixation improves outcomes of spinal fusion for c1.