OCCIPITO-ATLANTO-CERVICAL LATERAL MASS SCREWS FIXATION: PRELIMINARY REPORT FOR POSTERIOR SPINAL RECONSTRUCTION

Background : Lesions in the upper cervical region are numerous , and need decompression with optimum method offixation to avoid the complications of vertebral instability. Objective : A variety of techniques may be used to achieve fixation of the upper cervical spine, and in some cases can obviate the need for extending a fusion to the occiput . We present our preliminary report to achieve upper cervical fixation by lateral mass screws insertion in both occipit-cervical and atlanto-axial region . Methods And Results : During last two years twelve patients who ranged in age from 9 to 68 years old underwent posterior fixation for occipito-atanto-cervical instability Diagnosis include irreducible atlanto-occipital anterior subluxation associated with brain stem injury in one patient, fractured in CI and C2 with subluxation in two patients , irreducible fractured in C2 , C3 , C4 in three patients , chordoma in lower clival and extended to atlas and odontoid process in one patients , chronic unstable subluxation of CI over C2 in two patients and basilar invigination with total absence of CI and narrowing of foramen magnum in two patients , and lastly one patient had tuberculous destructive lesion of C2 and C3 . occipito- cervical fixation was achieved in 9 patients and atlanto-cervical in 3 patients. There were no major intraoperative complications except failure to insert one screw in one level . Rigid fixation was achieved in all patients . One patient still had quadriplegia and ventilator dependent. The patient of chordoma , the tumor recur aggressively within 3 months , the patient died due to aspiration pneumonia . Conclusions : Numerous methods of fixation have been developed over time and, within each of these, numerous modifications have been described. Occipito-atlanto-cervical fixation by lateral mass screws one of the method which can be used to provide safe and efficacious means of fixation.