Abstract
Although conventional C1 laminectomy is the gold standard for decompression at the
atlas, it provides little space for the bone graft to fuse. The fusion area can be
extended cranially up to the occipital bone, but it requires sacrificing the function
of the craniocervical junction. To date, no reports have focused on surgical techniques
for successful decompression and fusion without disruption of the posterior C1 arch
while providing enough room for the bone graft to fuse. This study introduces a new
technique for C1–C2 fusion and C1 double-door laminoplasty in patients with C1–C2
instability, canal stenosis, and cervical spondylotic myelopathy. A 66-year-old man
who had undergone C1–C2 fusion at a local clinic 2 years earlier visited our hospital
due to progressive myelopathy. A preoperative computed tomography (CT) scan showed
the tip of the odontoid process, extending into the spinal canal. On the axial view
of T2-weighted magnetic resonance images, the tip of the odontoid process significantly
compressed the spinal cord on the left side. The atlantodental interval was 7 mm on
radiography; however, C1–C2 instability was not evident on flexion-extension X-rays
due to the previous screw fixation. The patient underwent C1–C2 decompression and
fusion surgery with our new surgical technique. The segmental screws were repositioned
at C1 and C2, and we performed C1 double-door laminoplasty augmented with an allograft
spacer and a titanium miniplate. A marked reduction was seen at postoperative radiograph
and CT scan. Neurologic symptoms were relieved dramatically after surgery without
any discomfort. No complications were noted. We introduced a new surgical technique
that allows bone grafting, decompression, and fusion to be performed without disruption
of the posterior C1 arch in the event of C1–C2 canal stenosis combined with instability.
This technique may be indicated for other conditions that cause instability and stenosis
at the C1–C2 area.
Keywords
C1 laminoplasty - C1–C2 posterior fusion - C1–C2 instability - cervical myelopathy
- laminoplasty
