Modified inside-outside occipito-cervical plate system: Preliminary results

Sukru Caglar; Erhan Turkoglu; Hayri Kertmen; Bora Gurer; Huseyin Bozkurt; Rafet Ozay; Sahin Hanalioglu; Efkan Colpan

doi:10.4103/ajns.AJNS_305_17

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(01): 148-153
DOI: 10.4103/ajns.AJNS_305_17

Original Article

Modified inside-outside occipito-cervical plate system: Preliminary results

Authors

Sukru Caglar

Department of Neurosurgery, Ankara University, School of Medicine, Ankara
Erhan Turkoglu

¹Department of Neurosurgery, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Neurosurgery Clinic, Ankara
Hayri Kertmen

¹Department of Neurosurgery, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Neurosurgery Clinic, Ankara
Bora Gurer

²Department of Neurosurgery, Ministry of Health, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Neurosurgery Clinic, Istanbul
Huseyin Bozkurt

³Department of Neurosurgery, Cumhuriyet University, School of Medicine, Sivas
Rafet Ozay

¹Department of Neurosurgery, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Neurosurgery Clinic, Ankara
Sahin Hanalioglu

¹Department of Neurosurgery, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Neurosurgery Clinic, Ankara
Efkan Colpan

⁴Department of Neurological Surgery, UPMC Hamot, Erie, PA

Abstract

Context: Internal rigid fixation provides immediate stability of the occipito-cervical (OC) junction for treatment of instability; however, in current practice, the optimal OC junction stabilization method is debatable. Aims: The aim of this study to test the safety and efficacy of a newly designed modified inside-outside occipito-cervical (MIOOC) plate system for the treatment of instability. Settings and Design: This was a feasibility study of MIOCC plate system. Subjects and Methods: Five male and four female patients with OC instability were treated using MIOOC plate system. Stabilization rate, safety, and efficacy were evaluated radiologically and clinically. Results: Mean age of the patients was 35 ± 11 (range: 22–58) years. Etiology of OC instability included trauma, neoplasm, congenital abnormalities, and iatrogenic. The fusion levels ranged from occiput-C3 to occiput-C6. Mean follow-up duration was 22 ± 10 (range: 6–46) months. There were neither complication nor was there any need for plate revision or screw pullout. Mortality occurred in one patient due to primary malignancy at 6 months; otherwise, no morbidity was observed. During the follow-up, no recurrent subluxation or newly developed instability at adjacent levels occurred. All patients showed a satisfactory union at the most recent follow-up examination. Conclusions: These preliminary results suggest that the MIOCC plate system is a useful and safe method for providing immediate internal stability of the OC junction. Using a multi-piece plate design in this plate system provided easy implantation and a better interface between plate and OC bones. Further, clinical studies and long-term results are needed to determine the reliability of the MIOOC plate system.

Key-words:

Biomechanical system - C1–C2 fixation - craniovertebral junction - inside-outside - multi-piece plate - occipito-cervical

Full Text

References

References
1 Abumi K, Takada T, Shono Y, Kaneda K, Fujiya M. Posterior occipitocervical reconstruction using cervical pedicle screws and plate-rod systems. Spine (Phila Pa 1976) 1999;24:1425-34.
2 Crockard HA, Stevens JM. Craniovertebral junction anomalies in inherited disorders: Part of the syndrome or caused by the disorder? Eur J Pediatr 1995;154:504-12.
3 Dickman CA, Papadopoulos SM, Sonntag VK, Spetzler RF, Rekate HL, Drabier J, et al. Traumatic occipitoatlantal dislocations. J Spinal Disord 1993;6:300-13.
4 Fehlings MG, Errico T, Cooper P, Benjamin V, DiBartolo T. Occipitocervical fusion with a five-millimeter malleable rod and segmental fixation. Neurosurgery 1993;32:198-207.
5 Grob D, Dvorak J, Panjabi M, Froehlich M, Hayek J. Posterior occipitocervical fusion. A preliminary report of a new technique. Spine (Phila Pa 1976) 1991;16:S17-24.
6 Grob D, Dvorak J, Panjabi MM, Antinnes JA. The role of plate and screw fixation in occipitocervical fusion in rheumatoid arthritis. Spine (Phila Pa 1976) 1994;19:2545-51.
7 Jain VK, Mittal P, Banerji D, Behari S, Acharya R, Chhabra DK, et al. Posterior occipitoaxial fusion for atlantoaxial dislocation associated with occipitalized atlas. J Neurosurg 1996;84:559-64.
8 Sasso RC, Jeanneret B, Fischer K, Magerl F. Occipitocervical fusion with posterior plate and screw instrumentation. A long-term follow-up study. Spine (Phila Pa 1976) 1994;19:2364-8.
9 Smith MD, Anderson P, Grady MS. Occipitocervical arthrodesis using contoured plate fixation. An early report on a versatile fixation technique. Spine (Phila Pa 1976) 1993;18:1984-90.
10 Vale FL, Oliver M, Cahill DW. Rigid occipitocervical fusion. J Neurosurg 1999;91:144-50.
11 Zimmermann M, Wolff R, Raabe A, Stolke D, Seifert V. Palliative occipito-cervical stabilization in patients with malignant tumors of the occipito-cervical junction and the upper cervical spine. Acta Neurochir (Wien) 2002;144:783-90.
12 Elia M, Mazzara JT, Fielding JW. Onlay technique for occipitocervical fusion. Clin Orthop Relat Res 1992;280:170-4.
13 Pait TG, Al-Mefty O, Boop FA, Arnautovic KI, Rahman S, Ceola W, et al. Inside-outside technique for posterior occipitocervical spine instrumentation and stabilization: Preliminary results. J Neurosurg 1999;90:1-7.
14 Roberts DA, Doherty BJ, Heggeness MH. Quantitative anatomy of the occiput and the biomechanics of occipital screw fixation. Spine (Phila Pa 1976) 1998;23:1100-7.
15 Caglar YS, Torun F, Pait TG, Hogue W, Bozkurt M, Ozgen S, et al. Biomechanical comparison of inside-outside screws, cables, and regular screws, using a sawbone model. Neurosurg Rev 2005;28:53-8.
16 Naderi S, Usal C, Tural AN, Korman E, Mertol T, Arda MN, et al. Morphologic and radiologic anatomy of the occipital bone. J Spinal Disord 2001;14:500-3.
17 Zipnick RI, Merola AA, Gorup J, Kunkle K, Shin T, Caruso SA, et al. Occipital morphology. An anatomic guide to internal fixation. Spine (Phila Pa 1976) 1996;21:1719-24.
18 Haher TR, Yeung AW, Caruso SA, Merola AA, Shin T, Zipnick RI, et al. Occipital screw pullout strength. A biomechanical investigation of occipital morphology. Spine (Phila Pa 1976) 1999;24:5-9.
19 Huckell CB, Buchowski JM, Richardson WJ, Williams D, Kostuik JP. Functional outcome of plate fusions for disorders of the occipitocervical junction. Clin Orthop Relat Res 1999;359:136-45.
20 Abode-Iyamah KO, Dlouhy BJ, Lopez AJ, Menezes AH, Hitchon PW, Dahdaleh NS, et al. Comparison of hinged and contoured rods for occipitocervical arthrodesis in adults: A clinical study. J Craniovertebr Junction Spine 2016;7:171-5.
21 Steinmetz MP, Mroz TE, Benzel EC. Craniovertebral junction: Biomechanical considerations. Neurosurgery 2010;66:7-12.
22 Ebraheim NA, Lu J, Biyani A, Brown JA, Yeasting RA. An anatomic study of the thickness of the occipital bone. Implications for occipitocervical instrumentation. Spine (Phila Pa 1976) 1996;21:1725-9.
23 Barrey C, Mertens P, Jund J, Cotton F, Perrin G. Quantitative anatomic evaluation of cervical lateral mass fixation with a comparison of the Roy-Camille and the Magerl screw techniques. Spine (Phila Pa 1976) 2005;30:E140-7.
24 Hott JS, Lynch JJ, Chamberlain RH, Sonntag VK, Crawford NR. Biomechanical comparison of C1-2 posterior fixation techniques. J Neurosurg Spine 2005;2:175-81.
25 Zhao XL, Zhao HB, Wang B, Zhu XS, Li LZ, Zhang CQ, et al. Lower cervical spine injury treated with lateral mass plates and pedicle screws through posterior approach. Chin J Traumatol 2005;8:160-4.