Free Hand Direct Posterior Screw Insertion into Axis Body in High Vertebral Artery Groove

Background Data: Transpedicular screw is an important fixation technique of axis. It does not depend on intact posterior components like sublaminar wires or translaminar screws. Unlike transarticular screw, transpedicular screw provides segmental fixation so each screw is inserted independently. Mor...

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Autor principal:	Mohamed El-Gaidi
Formato:	article
Lenguaje:	EN
Publicado:	Egyptian Spine Association 2015
Materias:	Axis Fixation Direct body screw High Arched Vertebral Artery Groove Transpedicular screws Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/0ab26d5ed669478abd2b8f81e7d49d8c
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spelling	oai:doaj.org-article:0ab26d5ed669478abd2b8f81e7d49d8c2021-12-02T07:43:49ZFree Hand Direct Posterior Screw Insertion into Axis Body in High Vertebral Artery GrooveDOI:10.21608/ESJ.2015.39752314-89502314-8969https://doaj.org/article/0ab26d5ed669478abd2b8f81e7d49d8c2015-10-01T00:00:00Zhttp://www.esj.journals.ekb.eg/article_3975.htmlhttps://doaj.org/toc/2314-8950https://doaj.org/toc/2314-8969Background Data: Transpedicular screw is an important fixation technique of axis. It does not depend on intact posterior components like sublaminar wires or translaminar screws. Unlike transarticular screw, transpedicular screw provides segmental fixation so each screw is inserted independently. Moreover, it is biomechanically superior to other fixation methods. However, high arched vertebral artery groove (VAG), an anatomical variant may be present unilaterally up to 18 % of cases, presents a challenge that makes screw insertion hazardous due to risk of vertebral artery injury. Purpose: The aim of this work is to assess the safety, feasibility and limitations of a new free-hand technique of direct posterior screw insertion into axis body in case of C2 high arched VAG. Study Design: An anatomical-surgical study. Material and Methods: The morphology of C2 VAG was studied in 30 dry axis vertebrae. Results: High arched VAG was noted in (13.3%) of studied axis vertebrae (8 sides). In these 6 axis vertebrae with high arched VAG (2 bilateral and 4 unilateral), 8 screws were successfully inserted directly into the pedicle vertebral body interface with bicortical purchase. The entry point was 3-5 mm inferior to the superior facet of axis. The average screw angulation was 40±3.7° medially and 5.6±3.5° rostrally. The average screw length was 25.9±3.3mm while the average bone purchase distance inside axis body was 17.3±1.5mm. Conclusion: The direct posterior screw insertion into axis body is a feasible technique in case of high arched VAG, but further investigations are needed to assess the technique biomechanically and clinically. (2015ESJ093)Mohamed El-GaidiEgyptian Spine AssociationarticleAxis FixationDirect body screwHigh Arched Vertebral Artery GrooveTranspedicular screwsNeurology. Diseases of the nervous systemRC346-429ENEgyptian Spine Journal, Vol 16, Iss 1, Pp 5-13 (2015)
institution	DOAJ
collection	DOAJ
language	EN
topic	Axis Fixation Direct body screw High Arched Vertebral Artery Groove Transpedicular screws Neurology. Diseases of the nervous system RC346-429
spellingShingle	Axis Fixation Direct body screw High Arched Vertebral Artery Groove Transpedicular screws Neurology. Diseases of the nervous system RC346-429 Mohamed El-Gaidi Free Hand Direct Posterior Screw Insertion into Axis Body in High Vertebral Artery Groove
description	Background Data: Transpedicular screw is an important fixation technique of axis. It does not depend on intact posterior components like sublaminar wires or translaminar screws. Unlike transarticular screw, transpedicular screw provides segmental fixation so each screw is inserted independently. Moreover, it is biomechanically superior to other fixation methods. However, high arched vertebral artery groove (VAG), an anatomical variant may be present unilaterally up to 18 % of cases, presents a challenge that makes screw insertion hazardous due to risk of vertebral artery injury. Purpose: The aim of this work is to assess the safety, feasibility and limitations of a new free-hand technique of direct posterior screw insertion into axis body in case of C2 high arched VAG. Study Design: An anatomical-surgical study. Material and Methods: The morphology of C2 VAG was studied in 30 dry axis vertebrae. Results: High arched VAG was noted in (13.3%) of studied axis vertebrae (8 sides). In these 6 axis vertebrae with high arched VAG (2 bilateral and 4 unilateral), 8 screws were successfully inserted directly into the pedicle vertebral body interface with bicortical purchase. The entry point was 3-5 mm inferior to the superior facet of axis. The average screw angulation was 40±3.7° medially and 5.6±3.5° rostrally. The average screw length was 25.9±3.3mm while the average bone purchase distance inside axis body was 17.3±1.5mm. Conclusion: The direct posterior screw insertion into axis body is a feasible technique in case of high arched VAG, but further investigations are needed to assess the technique biomechanically and clinically. (2015ESJ093)
format	article
author	Mohamed El-Gaidi
author_facet	Mohamed El-Gaidi
author_sort	Mohamed El-Gaidi
title	Free Hand Direct Posterior Screw Insertion into Axis Body in High Vertebral Artery Groove
title_short	Free Hand Direct Posterior Screw Insertion into Axis Body in High Vertebral Artery Groove
title_full	Free Hand Direct Posterior Screw Insertion into Axis Body in High Vertebral Artery Groove
title_fullStr	Free Hand Direct Posterior Screw Insertion into Axis Body in High Vertebral Artery Groove
title_full_unstemmed	Free Hand Direct Posterior Screw Insertion into Axis Body in High Vertebral Artery Groove
title_sort	free hand direct posterior screw insertion into axis body in high vertebral artery groove
publisher	Egyptian Spine Association
publishDate	2015
url	https://doaj.org/article/0ab26d5ed669478abd2b8f81e7d49d8c
work_keys_str_mv	AT mohamedelgaidi freehanddirectposteriorscrewinsertionintoaxisbodyinhighvertebralarterygroove
_version_	1718399200568279040

Free Hand Direct Posterior Screw Insertion into Axis Body in High Vertebral Artery Groove

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