![c1 c2 c3 cervical spine x ray c1 c2 c3 cervical spine x ray](https://embed.widencdn.net/img/veritas/vwuxjlgkee/1200x630px/cervical-spine-vertebrae.png)
An immediate postoperative X-ray showed satisfactory reduction ( Fig. SSEPs and MEPs were noted to be stable throughout the procedure. The soft tissues were then closed in layers, a cervical collar was placed, and the patient was taken to the recovery room. Ceramic and a small strip of bone morphogenetic protein was used to completely fill the gap between the occiput and the cervical spine. Bone graft derived from the laminectomy and fusion mass was placed. The end caps on the occipital plate were then locked. Distraction between the rod holder and the occipital plate was used to translate C2 anteriorly, effecting the reduction. A rod holder was placed adjacent to the occipital plate ( Fig.
![c1 c2 c3 cervical spine x ray c1 c2 c3 cervical spine x ray](https://upload.orthobullets.com/topic/2018/images/extension%20teardrop.jpg)
The cervical screws were locked, and the end caps in the occipital plate were left loose. Reduction was performed as follows: A rod was contoured to connect the occipital plate and distal fixation. A midline occipital plate, C2 pars screws, and C3 lateral mass screws were placed. As such, the decision was made to perform an occipitalcervical fusion. Scarring made exposure of this area additionally difficult. The laminae and cables were removed en bloc, and no cerebral spinal leak occurred.īone graft from the patient's prior procedure was fused to the undersurface of C1 and obscured the C1 lateral mass. With the cervical spine exposed from the occiput to C3, laminectomy of C1 and C2 was achieved with a high-speed bur. The patient's neck was then prepared and draped, and a midline subperiosteal approach was performed with sharp dissection and bipolar electrocautery to avoid monopolar contact with the C1–2 cables. 9 C1 lateral mass screws may be difficult to place, however, in a revision or degenerative setting.Īs an alternative to the placement of C1 lateral mass screws, we describe occipital plating and fixation of C2 to affect atlantoaxial reduction and correction of cervical stenosis/instability. In cases of cervical stenosis and instability, placement of C1 lateral mass screws is a powerful alternative to the traditional use of wiring and transarticular screw fixation. Different instrumented reduction techniques may be particularly suited for each. 7– 10Ĭraniocervical subluxation and atlantoaxial subluxation produce a variety of deformities, for example, cranial settling, basilar invagination, and cervical stenosis. Instrumented reduction has been used to treat lumbar spondylolisthesis, 1– 3 thoracic fracture-dislocations, 4, 5 cervicothoracic deformity, 6 and most recently, craniocervical and atlantoaxial subluxation. Conclusions/Level of Evidence Spine surgeons may consider the described procedure a viable treatment alternative in problematic subluxations of the cervical spine.