頭蓋頸椎移行部病変における instrumentation (<特集>頭蓋頚椎移行部病変)

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Instrumentation for craniovertebral junction may be characterized by the variety and complexity. Three techniques for craniovertebral fusion, such as the occipitocervical loop fixation, C1/C2 transarticular screw fixation, and anterior odontoid screw fixation are discussed, including indications, advantages and disadvantages, based on our experience of 12 cases. The occipitocervical loop fixation is a method to fix the occipital bone and the cervical laminae, using a metal loop and wires. Immediate and strong fixation of the craniovertebral junction is obtained, although restriction of postoperative neck movement is severe. We used this techniques in 7 cases without any complications. Postoperative stability was excellent except for 2 patients with rheumatoid arthritis, whose anterior C1 archs sank slightly in the early postoperative period. The C1/C2 transarticular screw fixation (Magerl) is a method to fix the C1 and the C2 using two screws inserted into the bilateral facet joints. This method allows one of the strongest fixation of the C1/C2 segments, while it has potential risk to the spinal roots and vertebral arteries. We used this technique in 4 cases of atlantoaxial dislocation with higher instability. Three of them were associated with os odontoideum and the other with SLE. Good fusion was obtained in all these cases. One patient showed asymptomatic neck bruit due to an arteriovenous fistula from the injured right vertebral artery. The patient was successfully treated by endovascular coil embolization without any complications. The anterior odontoid screw fixation is another method to fix a fractured odontoid processes using a single screw or double ones inserted via an anterior cervical approach. The advantage of this method is that it can preserve neck movement postoperatively. However, the indication is very limited to cases with acute odontoid fracture type II without disruption of the cruciform ligament. We used this method only in one case. In conclusion, the best method should be selected in each case among a variety of techniques of instrumentation for craniovertebral instability.
1997-12-15

頭蓋頸椎移行部病変における instrumentation (<特集>頭蓋頚椎移行部病変)

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