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C1 lateral mass fixation: a comparison of constructs.

Praveen V Mummaneni1, Daniel C Lu, Sanjay S Dhall

  • 1Department of Neurological Surgery, University of California, San Francisco, San Francisco, California 94143-0112, USA. mummanenip@neurosurg.ucsf.edu

Neurosurgery
|February 23, 2010
PubMed
Summary

C1 lateral mass screw fixation offers high fusion rates and improved outcomes for cervical spine issues. However, occipitocervical constructs show higher complication and pseudoarthrosis rates compared to C1-C2 fixation.

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Area of Science:

  • Neurosurgery
  • Orthopedic Surgery
  • Spinal Surgery

Background:

  • C1 lateral mass screw fixation is a critical technique in upper cervical spine stabilization.
  • Different construct types (occipitocervical, C1-C2, C1-mid/low cervical) exist, each with potential benefits and drawbacks.

Purpose of the Study:

  • To review the technique and outcomes of C1 lateral mass screw fixation.
  • To compare the efficacy and complication rates of three distinct C1 lateral mass screw constructs.

Main Methods:

  • Retrospective review of 42 patients undergoing C1 lateral mass fixation.
  • Analysis of occipitocervical (OC), C1-C2, and C1 to mid/low cervical constructs.
  • Assessment of fusion via X-rays and CT scans; outcomes measured by VAS pain and Nurick grade.

Main Results:

  • Significant improvement in visual analog scale (VAS) neck pain and Nurick scores.
  • C1-C2 constructs demonstrated a 0% complication rate, significantly lower than OC (38%) and C1-mid/low cervical (17%) constructs.
  • Occipitocervical constructs had the highest complication and pseudoarthrosis rates (13%).

Conclusions:

  • C1 lateral mass fixation provides high fusion rates, pain reduction, and functional improvement.
  • C1 lateral mass screws are effective without C2 pedicle screws, compatible with C2 pars, translaminar, and C3 lateral mass screws.
  • Extending constructs cranially to the occiput or caudally below C2 increases complication and pseudoarthrosis risks.