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Subaxial Sagittal Alignment After Atlantoaxial Fixation Techniques

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Title: Subaxial Sagittal Alignment After Atlantoaxial Fixation Techniques
Authors: Oshima, Shigeki Browse this author
Sudo, Hideki Browse this author →KAKEN DB
Ito, Manabu Browse this author →KAKEN DB
Abumi, Kuniyoshi Browse this author
Keywords: C1 lateral mass screw
Magerl procedure
C1-C2 fixation angle
subaxial sagittal alignment
Issue Date: Feb-2015
Publisher: Lippincott Williams & Wilkins
Journal Title: Journal of spinal disorders & techniques
Volume: 28
Issue: 1
Start Page: E49
End Page: E55
Publisher DOI: 10.1097/BSD.0000000000000144
PMID: 25093649
Abstract: Study Design: A retrospective clinical case series. Objectives: To evaluate the association between C1-C2 fixation angle and postoperative C2-C7 alignment in the sagittal plane after C1 lateral mass screw with C2 pedicle screw fixation (C1-LMS) or Magerl with wiring technique. Summary of Background Data: Various techniques for posterior correction and fusion, such as the Magerl procedure with posterior wiring and C1-LMS procedures, are used for treating atlantoaxial instability. However, only few studies investigating the relationship between postoperative C1-C2 angle and C2-C7 sagittal alignment change after C1-C2 fixation have been reported. Methods: We retrospectively followed up 42 patients who underwent the C1-LMS (22 patients) or Magerl with wiring procedure (20 patients) to treat C1-C2 instability for > 2 years. The atlantodental interval, space available for the spinal cord, and O-C1, C1-C2, C2-C3, and C2-C7 angles were measured. Results: Significant reduction in atlantodental interval and increase in space available for the spinal cord were observed in both groups. Although the preoperative C1-C2 angles were similar, the angle at the final follow-up was higher in the Magerl with wiring group than in the C1-LMS group (P < 0.01). The C1-C2 fixation and postoperative C2-C7 angles were negatively correlated in both groups (C1-LMS group, r = -0.55, P < 0.01; Magerl with wiring, r = -0.62, P < 0.01). Conclusions: Increased lordotic change in the C1-C2 angle was associated with increased kyphotic changes in the C2-C7 angle after both procedures. The C1-LMS procedure effectively controlled C1-C2 sagittal alignment during surgery. To decrease the risk of postoperative subaxial kyphotic changes, the C1-C2 fixation angle should be carefully determined.
Rights: This is a non-final version of an article published in final form in "Journal of Spinal Disorders & Techniques. 28(1):E49-E55, February 2015".
Type: article (author version)
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 須藤 英毅

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