頭蓋頚椎移行部病変に対する後方固定術―Ｃ１外側塊スクリュー／Ｃ２椎弓根スクリューの有用性:—C1外側塊スクリュー/C2椎弓根スクリューの有用性
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OBJECTIVE: The craniocervical junction(CCJ) diseases often require posterior fixation surgery. For the treatment of the CCJ diseases, C1-2 transarticular screw (Magerl technique) which was used as an anchor screw in combination with other cervical instrumentation or for atlantoaxial fixation provides immediate stability and rigid fixation. However, the technique remains technically demanding and has hazardous complications. Recently, C1 lateral mass screw(C1LMS) and C2 pedicle screw(C2PS) have been used for the posterior instrumentation. We reviewed 13 cases of the CCJ diseases treated by using C1LMS and/or C2PS. MATERIAL AND METHODS: Between June 2003 and July 2006, 13 patients (6 male, 7 female) who ranged in age from 21 to 77 years-old underwent posterior fixation using C1LMS and/or C2PS. Five patients had atlantoaxial subluxation due to rheumatoid arthritis, four had congenital abnormalities including Chiari I and os odontoideum, two had degenerative articular cyst due to CCJ instability and two had traumatic lesions. All cases used navigation systems preoperatively to confirm the feasibility of implanting screws. All screws were placed under lateral fluoroscopic guidance. RESULT: Both C1LMS and C2PS were used to achieve atlantoaxial or occipitocervical fixation in nine patients. Combining either C1LMS or C2PS with other cervical instrumentation were used to achieve atlantocervical or occipitocervical fixation in four. There were no permanent complications. In all cases rigid fixation was confirmed on postoperative radiographs and maintained on follow-up radiographs. CONCLUSION: We suggest that C1LMS and C2PS are efficacious in posterior fixation for CCJ diseases. Particularly, in cases precluding to achieve posterior instrumentation including C1-2 transarticular screw, this procedure provides rigid fixation and the feasibility of short fusion in safety.
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