Cervical 1-2 Posterior Instrumented Fusion Utilizing Computer-Assisted Navigation With Harvest of Rib Strut Autograft: 2-Dimensional Operative Video

Authors

Timothy J. Yee, Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
Michael J. Strong, Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
Matthew S. Willsey, Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
Mark E. Oppenlander, Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.

Document Type

Article

Abstract

Nonunion of a type II odontoid fracture after the placement of an anterior odontoid screw can occur despite careful patient selection. Countervailing factors to successful fusion include the vascular watershed zone between the odontoid process and body of C2 as well as the relatively low surface area available for fusion. Patient-specific factors include osteoporosis, advanced age, and poor fracture fragment apposition. Cervical 1-2 posterior instrumented fusion is indicated for symptomatic nonunion. The technique leverages the larger posterolateral surface area for fusion and does not rely on bony growth in a watershed zone. Although loss of up to half of cervical rotation is expected after C1-2 arthrodesis, this may be better tolerated in the elderly, who may have lower physical demands than younger patients. In this video, we discuss the case of a 75-yr-old woman presenting with intractable mechanical cervicalgia 7 mo after sustaining a type II odontoid fracture and undergoing anterior odontoid screw placement at an outside institution. Cervical radiography and computed tomography exhibited haloing around the screw and nonunion across the fracture. We demonstrate C1-2 posterior instrumented fusion with Goel-Harms technique (C1 lateral mass and C2 pedicle screws), utilizing computer-assisted navigation, and modified Sonntag technique with rib strut autograft. Posterior C1-2-instrumented fusion with rib strut autograft is an essential technique in the spine surgeon's armamentarium for the management of C1-2 instability, which can be a sequela of type II dens fracture. Detailed video demonstration has not been published to date. Appropriate patient consent was obtained.

Medical Subject Headings

Aged; Autografts; Computers; Female; Humans; Odontoid Process (diagnostic imaging, injuries, surgery); Ribs; Spinal Fractures (diagnostic imaging, surgery)

Publication Date

5-13-2021

Publication Title

Operative neurosurgery (Hagerstown, Md.)

E-ISSN

2332-4260

Volume

20

Issue

6

First Page

E433

PubMed ID

33571358

Digital Object Identifier (DOI)

10.1093/ons/opab029

Recommended Citation

Yee, Timothy J.; Strong, Michael J.; Willsey, Matthew S.; and Oppenlander, Mark E., "Cervical 1-2 Posterior Instrumented Fusion Utilizing Computer-Assisted Navigation With Harvest of Rib Strut Autograft: 2-Dimensional Operative Video" (2021). Neurosurgery. 1610.
https://scholar.barrowneuro.org/neurosurgery/1610