Posterior stabilization of C2 metastases by combination of atlantoaxial screw fixation and hook plate

Summary

A new technique for the stabilization of metastatic cervical instability of the axis and/or neighboring vertebrae at lower levels is described. By a combination of the transarticular screw fixation C1/2 (Magerl) with the hook plate technique (Magerl) (or facultatively with a 1/3 tubular or 3.5 mm dynamic compression plate) from a posterior approach, the risks and stresses on the patient of a transoral or a combined extended technique are avoided, creating a proven biomechanically stable situation. The new technique is particularly helpful in those patients with a rapid progression of their malignant disease in whom local tumor growth is not expected to compress the spinal cord, and palliative stabilization of the unstable upper cervical spine can avoid neurological deficits or alleviate pain syndromes at a minimized morbidity due to surgery. The new technique has been successfully applied in a limited clinical series of four patients with metastasis of the cervical spine, resulting in substantial improvement of the general condition and cervical pain syndrome and stability of the assemblage during the observation period (4–9 months).