title: The reinforcement of a C2 laminar screw by a C2 laminar hook as an anchor of occipito-C2 fusion.
abstract: Although a C1-C2 transarticular screw (TAS) or a C2 pedicle screw (PS) is the most rigid anchor for C2, each entails the risk of vertebral artery injury. Although a C2 laminar screw (LS) is often used as an alternative anchor in such cases, its anchoring strength may be inadequate. We introduce a technical tip, in which a C2 LS is reinforced by a C2 infralaminar hook without extending the fusion range. Six patients, for whom a unilateral TAS or C2 PS was risky or impossible, were treated with O-C2 fusion using this technique. The post-operative course of each patient was uneventful. Bone union was achieved in all patients, except one who died of indifferent disease before the confirmation of bone union by computed tomography. This method would be a safe and non-technical-demanding option when the placement of a TAS or PS is risky or impossible.
authors.affiliation: Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, 569-8686, Japan, neo@poh.osaka-med.ac.jp.
authors.forename: Masashi
authors.initials: M
authors.lastname: Neo
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshitomi
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Takemoto
authors.forename: Masanori
authors.initials: M
authors.lastname: Izeki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D001368:Axis, Cervical Vertebra / Q000000981:diagnostic imaging / Q000601:surgery; D001863:Bone Screws; D001270:Cervical Atlas / Q000000981:diagnostic imaging / Q000601:surgery; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D009777:Occipital Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods*; D014057:Tomography, X-Ray Computed; D014711:Vertebral Artery / Q000293:injuries / Q000601:surgery