title: Percutaneous atlantoaxial anterior transarticular screw fixation combined with mini-open posterior C1/2 wire fusion for patients with a high-riding vertebral artery.
abstract: OBJECTIVE
  To describe the technique and clinical results of percutaneous atlantoaxial anterior transarticular fixation combined with limited exposure posterior C1/2 arthrodesis in patients with a high-riding vertebral artery.
  
  
  METHODS
  Zhejiang Spine Center, China.
  
  
  METHODS
  Five patients with a high-riding vertebral artery and an upper cervical fracture.
  
  
  METHODS
  Percutaneous atlantoaxial anterior transarticular screw fixation combined with limited exposure posterior C1/2 wire fusion.
  
  
  METHODS
  Computed tomography scans were used to assess the high-riding vertebral artery and feasibility of anterior transarticular screw fixation preoperatively. A Philadelphia collar was used to immobilize the neck postoperatively. Anteroposterior (open-mouth) and lateral views were obtained at pre/postoperation and at the follow-up.
  
  
  RESULTS
  The operation was performed successfully on all of the patients, and no intraoperative operation-related complications such as nerve injury, vertebral artery, and soft tissue complications occurred. The mean follow-up period was 33.8 months (range: 24 to 58 months). No screw breakage, loosening, pullout, or cutout was observed. Bone union was achieved in all patients at the last follow-up.
  
  
  CONCLUSIONS
  Our small case series results suggested that percutaneous anterior transarticular screw fixation combined with mini-open posterior C1/2 wire fusion is a technically minimally invasive, safe, feasible, and useful method to treat patients with a high-riding vertebral artery.
authors: a Department of Spinal Surgery , Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spine Center , Wenzhou , Zhejiang , People's Republic of China.
authors: Ai-Min
authors: AM
authors: Wu
authors: a Department of Spinal Surgery , Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spine Center , Wenzhou , Zhejiang , People's Republic of China.
authors: Xiang-Yang
authors: XY
authors: Wang
authors: a Department of Spinal Surgery , Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spine Center , Wenzhou , Zhejiang , People's Republic of China.
authors: Feng
authors: F
authors: Zhou
authors: a Department of Spinal Surgery , Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spine Center , Wenzhou , Zhejiang , People's Republic of China.
authors: Xiao-Lei
authors: XL
authors: Zhang
authors: a Department of Spinal Surgery , Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spine Center , Wenzhou , Zhejiang , People's Republic of China.
authors: Hua-Zi
authors: HZ
authors: Xu
authors: a Department of Spinal Surgery , Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spine Center , Wenzhou , Zhejiang , People's Republic of China.
authors: Yong-Long
authors: YL
authors: Chi
mesh_terms: D000368:Aged; D001268:Atlanto-Axial Joint / Q000601:surgery*; D001863:Bone Screws / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059348:Peripheral Nerve Injuries / Q000209:etiology; D011183:Postoperative Complications; D016103:Spinal Fractures / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000379:methods*; D014711:Vertebral Artery / Q000473:pathology*
keywords: Anterior transarticular screw fixation; Gallie fusion; High-riding vertebral artery; Minimally invasive; Percutaneous