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Modified C1 lateral mass screw insertion using a threaded K-wire. A technical note.
Amanda Paterson1, Stephen Byrne2, Mitchell Hansen1
1Department of Neurosurgery, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia.
Summary
This study presents a safe C1-C2 fixation technique using a threaded K-wire, reducing bleeding and operative time for spinal instability. It offers an effective alternative where advanced imaging is unavailable.
Area of Science:
- Neurosurgery
- Spine Surgery
- Orthopedic Surgery
Background:
- C1-C2 motion segment instability requires surgical fixation.
- Traditional C1 lateral mass screw placement risks significant bleeding from the C2 nerve root and venous plexus.
- Limited access to image guidance in some hospitals necessitates alternative techniques.
Purpose of the Study:
- To describe and evaluate a modified technique for C1 lateral mass screw insertion using a threaded K-wire.
- To reduce dissection of the C2 nerve root and minimize intraoperative hemorrhage.
- To assess the safety and efficacy of this technique in patients undergoing C1-C2 instrumented fixation.
Main Methods:
- Retrospective analysis of 18 consecutive patients undergoing C1-C2 instrumented fixation.
- Utilized a technique involving insertion of a C1 lateral mass screw over a threaded K-wire.
- Indications included trauma, odontoid fracture non-union, pathological fractures, and inflammatory conditions.
Main Results:
- All 18 patients achieved successful C1-C2 stabilization.
- Blood loss did not exceed 400ml in any patient.
- No vertebral artery injuries or neurological deterioration were observed.
Conclusions:
- The threaded K-wire technique for C1 lateral mass screw insertion is safe and effective.
- This method reduces the risk of neurological and vertebral artery injury.
- It offers a valuable modification to standard procedures, particularly in resource-limited settings.
