Related Experiment Video
Updated: May 24, 2026
Clinical Application of Microscope-Assisted Minimally Invasive Anterior Lumbar Interbody Fusion
Published on: June 16, 2023
Minimally invasive posterior atlantoaxial fusion: a cadaveric and clinical feasibility study
Alexander Taghva1, Frank J Attenello, Gabriel Zada
1Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Objective:
Minimally invasive surgical (MIS) techniques have several potential advantages for the patient over open techniques, including decreased loss of blood, postoperative pain, and recovery time. We aimed to demonstrate atlantoaxial fusion by using the MIS techniques, shown previously in only two reports. A smaller operating corridor with MIS may increase difficulty of instrumentation placement and risk of instrumentation-related complications.
Methods:
Five cadaveric specimens were studied presurgically with computed tomography (CT) to determine bony anatomy, vertebral artery course, and the trajectory for C1/C2 screw placement. Four specimens had adequate C2 pedicle sizes to accommodate screw placement. Specimens were used to perform C1-2 instrumentation through minimal access tubular retractors. After procedures, specimens were re-examined with CT to assess accuracy of MIS C1-2 screw placement.
Results:
Through minimal access expandable tubular retractors, C1-lateral mass and C2 pedicle screws were placed in all four specimens. Postinstrumentation CT analysis demonstrated no violation of the foramen transversarium in all cases. There was one grade 1 medial breach from C1 lateral mass screw placement. Two patients with type-2 odontoid fractures were treated with MIS C1-2 fusion with follow-up 4-24 months. Average operating time was 3.5 hours, and average surgical blood loss was 125 mL. Both cases were examined with CT scan postsurgically, and there were no bony breaches with screw placement. Both patients remained neurologically intact postoperatively, with significant improvement revealed in pain scores. Follow-up imaging at two years demonstrated union of odontoid fracture.
Conclusions:
Minimally invasive atlantoaxial fixation is feasible and safe. Preoperative CT is paramount for preoperative evaluation of the vertebral artery anatomy in relation to C1/2 vertebra.
Insights
Minimally invasive atlantoaxial fixation using C1-lateral mass and C2 pedicle screws is feasible and safe. This technique offers reduced blood loss and improved pain scores for patients with odontoid fractures.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Fusion Techniques
Background:
- Minimally invasive surgical (MIS) techniques offer potential patient benefits over open surgery, including reduced blood loss, pain, and recovery time.
- Atlantoaxial fusion via MIS approaches is sparsely reported, with potential challenges in instrumentation placement.
- This study aimed to demonstrate the feasibility and safety of MIS atlantoaxial fixation.
Observation:
- Preoperative CT scans guided C1/C2 screw trajectory planning in five cadaveric specimens.
- MIS C1-2 instrumentation was performed using minimal access tubular retractors.
- Postoperative CT assessed the accuracy of screw placement and potential complications.
Findings:
- C1-lateral mass and C2 pedicle screws were successfully placed in four specimens, with no foramen transversarium violations.
- One minor C1 screw breach occurred; however, clinical cases showed no bony breaches postoperatively.
- Two patients with type-2 odontoid fractures treated with MIS C1-2 fusion demonstrated union, improved pain scores, and remained neurologically intact.
Implications:
- Minimally invasive atlantoaxial fixation is a viable and safe surgical option.
- Preoperative CT evaluation is crucial for assessing vertebral artery anatomy relative to C1/2 vertebrae.
- MIS techniques may offer advantages for patients undergoing atlantoaxial fusion, particularly for odontoid fractures.
