Abstract
Purpose
Cranio-vertebral junction fixation is challenging due to the complex topographical anatomy and the presence of important anatomical structures. There are several limitations to the traditional occipital squama fixation methods. The purpose of this work is to assess the safety and feasibility of a new optimum trajectory of occipital condyle (OC) screws for occipitocervical fixation via a free-hand technique.
Methods
Eight different parameters of OC morphology were studied in fifty adult skulls. Free-hand placement of OC screws was performed in five cadavers using 3.5-mm titanium polyaxial screws and a 3-mm rod construct (C0–C1–C2). Postoperative computed tomography was performed to determine the success of the screw placement and their angulation, length and effect on hypoglossal canal volume.
Results
The average length, width and height of the OC were 24.2 ± 3.6, 14.2 ± 1.9, and 10.7 ± 2 mm, respectively. The average medio-lateral, hypoglossal canal and atlanto-occipital joint angles were 38.8° medially ±5°, 7.4° rostrally ±1.9° and 23.4° caudally ±3.5°, respectively. The ten screws were successfully inserted using a free-hand technique with bicortical purchase. There was no vertebral artery injury or breach of the hypoglossal canal in any specimen. The average screw length was 22.2 ± 3.9 mm. The average medio-lateral angle was 30° medially ±6.7°. The average cranio-caudal angle was 4° caudally ±6.2°.
Conclusions
The free-hand technique of OC screw placement is a safe and viable option for occipitocervical fixation and may be a preferred alternative in selected cases. However, further studies are needed to compare its safety and reliability to other more established methods.
Similar content being viewed by others
References
Abumi K, Takada T, Shono Y, Kaneda K, Fujiya M (1999) Posterior occipitocervical reconstruction using cervical pedicle screws and plate-rod systems. Spine 24:1425–1434
Al-Mefty O, Borba LA, Aoki N, Angtuaoco E, Pait TG (1996) The transcondylar approach to extradural nonneoplastic lesions of the craniovertebral junction. J Neurosurg 84:1–6
Bekelis K, Duhaime AC, Missios S, Belden C, Simmons N (2010) Placement of occipital condyle screws for occipitocervical fixation in a pediatric patient with occipitocervical instability after decompression for Chiari malformation. J Neurosurg Pediatr 6:171–176
Ding X, Abumi K, Ito M, Sudo H, Takahata M, Nagahama K, Iwata A (2012) A retrospective study of congenital osseous anomalies at the craniocervical junction treated by occipitocervical plate-rod systems. Eur Spine J 21(8):1580–1589
de Oliveira E, Rhoton AL Jr, Peace D (1985) Microsurgical anatomy of the region of the foramen magnum. Surg Neurol 24:293–352
Frankel BM, Hanley M, Vandergrift A, Monroe T, Morgan S, Rumboldt Z (2010) Posterior occipitocervical (C0-3) fusion using polyaxial occipital condyle to cervical spine screw and rod fixation: a radiographic and cadaveric analysis. J Neurosurg Spine 12(5):509–516
Grob D, Dvorak J, Panjabi M, Froehlich M, Hayek J (1991) Posterior occipitocervical fusion. A preliminary report of a new technique. Spine 16:S17–S24
Helgeson MD, Lehman RA Jr, Sasso RC, Dmitriev AE, Mack AW, Riew KD (2011) Biomechanical analysis of occipitocervical stability afforded by three fixation techniques. Spine J 11(3):245–250
Karasu A, Cansever T, Batay F, Sabanci PA, Al-Mefty O (2009) The microsurgical anatomy of the hypoglossal canal. Surg Radiol Anat 31:363–367
Kosnik-Infinger L, Glazier SS, Frankel BM (2014) Occipital condyle to cervical spine fixation in the pediatric population. J Neurosurg Pediatr 13:45–53
la Marca F, Zubay G, Morrison T, Karahalios D (2008) Cadaveric study for placement of occipital condyle screws: technique and effects on surrounding anatomic structures. J Neurosurg Spine 9(4):347–353
Le TV, Vivas AC, Baaj AA, Vale FL, Uribe JS (2014) Optimal trajectory for the occipital condyle screw. J Spinal Disord Tech 27:93–97
Lin SL, Xia DD, Chen W, Li Y, Shen ZH, Wang XY, Xu HZ, Chi YL (2014) Computed tomographic morphometric analysis of the pediatric occipital condyle for occipital condyle screw placement. Spine (Phila Pa 1976) 39(3):E147–E152
Muthukumar N, Swaminathan R, Venkatesh G, Bhanumathy SP (2005) A morphometric analysis of the foramen magnum region as it relates to the transcondylar approach. Acta Neurochir (Wien) 147(8):889–895
Naderi S, Korman E, Citak G, Güvencer M, Arman C, lu Seno M, Tetik S, Arda MN (2005) Morphometric analysis of human occipital condyle. Clin Neurol Neurosurg 107:191–199
Nadim Y, Lu J, Sabry FF, Ebraheim N (2000) Occipital screws in occipitocervical fusion and their relation to the venous sinuses: an anatomic and radiographic study. Orthopedics 23:717–719
Ozer MA, Celik S, Govsa F, Ulusoy MO (2011) Anatomical determination of a safe entry point for occipital condyle screw using three-dimensional landmarks. Eur Spine J 20:1510–1517
Pait TG, Al-Mefty O, Boop FA, Arnautovic KI, Rahman S, Ceola W (1999) Inside-outside technique for occipitocervical spine instrumentation and stabilization: preliminary results. J Neurosurg 90(1 Suppl):1–7
Randazzo CG, LeBude B, Ratliff J, Harrop J (2010) Occiput–cervical fixation. In: Patel VV et al (eds) Spine Trauma. Springer-Verlag, Berlin, Heidelberg, pp 119–127
Sonntag VK, Dickman CA (1995) Occipitocervical instrumentation. In: Hitchon PW, Traynelis VC, Rengachary SS (eds) Techniques in spinal fusion and stabilization. Thieme, New York, pp 107–121
Suchomel P, Choutka O, Barsa P (2011) Surgical anatomy. In: Suchomel P, Choutka O (eds) Reconstruction of upper cervical spine and craniovertebral junction. Springer-Verlag, Berlin, Heidelberg, pp 3–15
Takigawa T, Simon P, Espinoza Orías AA, Hong JT, Ito Y, Inoue N, An HS (2012) Biomechanical comparison of occiput-C1-C2 fixation techniques: C0–C1 transarticular screw and direct occiput condyle screw. Spine (Phila Pa 1976) 37(12):E696–E701
Uribe JS, Ramos E, Vale F (2008) Feasibility of occipital condyle screw placement for occipitocervical fixation: a cadaveric study and description of a novel technique. J Spinal Disord Tech 21(8):540–546
Uribe JS, Ramos E, Youssef AS, Levine N, Turner AW, Johnson WM, Vale FL (2010) Craniocervical fixation with occipital condyle screws: biomechanical analysis of a novel technique. Spine (Phila Pa 1976) 35(9):931–938
Wen HT, Rhoton AL Jr, Katsuta T, de Oliveira E (1997) Microsurgical anatomy of the transcondylar, supracondylar, and paracondylar extensions of the far-lateral approach. J Neurosurg 87:555–585
Conflict of interest
There are no competing interests, and this study did not receive any funds. No benefits in any form have been or will be received from any commercial party directly or indirectly related to the subject of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
El-Gaidi, M.A., Eissa, E.M. & El-Shaarawy, E.A.A. Free-hand placement of occipital condyle screws: a cadaveric study. Eur Spine J 23, 2182–2188 (2014). https://doi.org/10.1007/s00586-014-3488-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-014-3488-3