{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T18:04:07Z","timestamp":1786125847536,"version":"build-2736575974"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2020,12,2]],"date-time":"2020-12-02T00:00:00Z","timestamp":1606867200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Numerous C1-C2 fixation techniques exist for the treatment of atlantoaxial instability. Limitations of screw-rod and sublaminar wiring techniques include C2 nerve root sacrifice and dural injury, respectively. We present a novel technique that utilizes a femoral head allograft cut with a keyhole that rests posteriorly on the arches of C1 and C2 and straddles the C2 spinous process, secured by sutures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To offer increased fusion across C1-C2 without the passage of sublaminar wiring or interarticular arthrodesis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A total of 6 patients with atlantoaxial instability underwent C1-C2 fixation using our method from 2015 to 2016. After placement of a C1-C2 screw\/rod construct, a cadaveric frozen femoral head allograft was cut into a half-dome with a keyhole and placed over the already decorticated dorsal C1 arch and C2 spinous process. Notches were created in the graft and sutures were placed in the notches and around the rods to secure it firmly in place.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The femoral head's shape allowed for creation of a graft that provides excellent surface area for fusion across C1-C2. There were no intraoperative complications, including dural tears. Postoperatively, no patients had sensorimotor deficits, pain, or occipital neuralgia. 5 patients demonstrated clinical resolution of symptoms by 3 mo and radiographic (computed tomography) evidence of fusion at 1 yr. One patient had good follow-up at 1 mo but died due to complications of Alzheimer disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>The posterior arch femoral head allograft strut technique with securing sutures is a viable option for supplementing screw-rod fixation in the treatment of complex atlantoaxial instability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ons\/opaa336","type":"journal-article","created":{"date-parts":[[2020,12,3]],"date-time":"2020-12-03T01:13:27Z","timestamp":1606958007000},"page":"226-231","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Supplementation of Screw-Rod C1-C2 Fixation With Posterior Arch Femoral Head Allograft Strut"],"prefix":"10.1227","volume":"20","author":[{"given":"David D","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kendall","family":"Rivera-Lane","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6282-828X","authenticated-orcid":false,"given":"Owen P","family":"Leary","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9551-0123","authenticated-orcid":false,"given":"Nathan J","family":"Pertsch","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4159-5365","authenticated-orcid":false,"given":"Tianyi","family":"Niu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joaquin Q","family":"Camara-Quintana","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adetokunbo A","family":"Oyelese","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6336-5950","authenticated-orcid":false,"given":"Jared S","family":"Fridley","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3187-5697","authenticated-orcid":false,"given":"Ziya L","family":"Gokaslan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,2]]},"reference":[{"issue":"10","key":"bib1-20251027","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1007\/s00381-008-0606-8","article-title":"Anatomy and biomechanics of normal craniovertebral junction (a) and biomechanics of stabilization (b)","volume":"24","author":"Menezes","year":"2008","journal-title":"Childs Nerv Syst"},{"issue":"18","key":"bib2-20251027","doi-asserted-by":"crossref","first-page":"1894","DOI":"10.1097\/00007632-199909150-00006","article-title":"Differential biomechanical effects of injury and wiring at C1-C2","volume":"24","author":"Crawford","year":"1999","journal-title":"Spine"},{"issue":"6","key":"bib3-20251027","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1097\/00006123-200212000-00004","article-title":"Atlantoaxial fixation using plate and screw method: a report of 160 treated patients","volume":"51","author":"Goel","year":"2002","journal-title":"Neurosurgery"},{"issue":"1-2","key":"bib4-20251027","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/BF01400872","article-title":"Plate and screw fixation for atlanto-axial subluxation","volume":"129","author":"Goel","year":"1994","journal-title":"Acta Neurochir (Wien)"},{"issue":"22","key":"bib5-20251027","doi-asserted-by":"crossref","first-page":"2467","DOI":"10.1097\/00007632-200111150-00014","article-title":"Posterior C1-C2 fusion with polyaxial screw and rod fixation","volume":"26","author":"Harms","year":"2001","journal-title":"Spine (Phila Pa 1976)"},{"issue":"3","key":"bib6-20251027","doi-asserted-by":"crossref","first-page":"279","DOI":"10.2106\/00004623-197860030-00001","article-title":"Atlanto-axial arthrodesis by the wedge compression method","volume":"60","author":"Brooks","year":"1978","journal-title":"J Bone Joint Surg Am"},{"issue":"2","key":"bib7-20251027","doi-asserted-by":"crossref","first-page":"190","DOI":"10.3171\/jns.1991.74.2.0190","article-title":"The interspinous method of posterior atlantoaxial arthrodesis","volume":"74","author":"Dickman","year":"1991","journal-title":"J Neurosurg"},{"issue":"3","key":"bib8-20251027","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1016\/S0002-9610(39)90309-0","article-title":"Fractures and dislocations of the cervical spine","volume":"46","author":"Gallie","year":"1939","journal-title":"Am J Surg"},{"issue":"1","key":"bib9-20251027","first-page":"65","article-title":"C1-C2 transarticular screw fixation for atlantoaxial instability: a 6-year experience","volume":"49","author":"Haid","year":"2001","journal-title":"Neurosurgery"},{"issue":"1","key":"bib10-20251027","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1007\/s00586-011-1958-4","article-title":"Modified technique for C1-2 screw-rod fixation and fusion using autogenous bicortical iliac crest graft","volume":"21","author":"Ni","year":"2012","journal-title":"Eur Spine J"},{"issue":"1","key":"bib11-20251027","doi-asserted-by":"crossref","first-page":"e87676","DOI":"10.1371\/journal.pone.0087676","article-title":"Bilateral C1-C2 transarticular screw and C1 laminar hook fixation and bone graft fusion for reducible atlantoaxial dislocation: a seven-year analysis of outcome","volume":"9","author":"Guo","year":"2014","journal-title":"PLoS One"},{"issue":"4","key":"bib12-20251027","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1227\/00006123-199510000-00012","article-title":"C1-C2 posterior cervical fusion: long-term evaluation of results and efficacy","volume":"37","author":"Coyne","year":"1995","journal-title":"Neurosurgery"},{"key":"bib13-20251027","first-page":"234","article-title":"Risk of spinal cord damage from sublaminar wiring or cable in Magerl\/Brooks technique for treatment of atlantoaxial subluxation","volume":"27","author":"Kato","year":"1999","journal-title":"Proc Cervical Spine Res Soc."},{"issue":"1","key":"bib14-20251027","doi-asserted-by":"crossref","first-page":"23","DOI":"10.3171\/spi.2005.2.1.0023","article-title":"Impact of interlaminar graft materials on the fusion status in atlantoaxial transarticular screw fixation","volume":"2","author":"Matsumoto","year":"2005","journal-title":"J Neurosurg Spine"},{"issue":"12","key":"bib15-20251027","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1302\/2058-5241.160025","article-title":"Bone grafts, bone graft extenders, substitutes and enhancers for acetabular reconstruction in revision total hip arthroplasty","volume":"1","author":"Pierannunzii","year":"2016","journal-title":"EFORT Open Rev"},{"issue":"12","key":"bib16-20251027","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.3928\/0147-7447-20051201-15","article-title":"Acetabular reconstruction in revision hip surgery using femoral head block allograft","volume":"28","author":"Piriou","year":"2005","journal-title":"Orthopedics"},{"issue":"15","key":"bib17-20251027","doi-asserted-by":"crossref","first-page":"E902","DOI":"10.1097\/BRS.0000000000000395","article-title":"A cost-effective method for femoral head allograft procurement for spinal arthrodesis: an alternative to commercially available allograft","volume":"39","author":"Brown","year":"2014","journal-title":"Spine (Phila Pa 1976)"},{"issue":"5","key":"bib18-20251027","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1227\/NEU.0000000000000306","article-title":"C2 nerve root transection during C1 lateral mass screw fixation: does it affect functionality and quality of life","volume":"74","author":"Dewan","year":"2014","journal-title":"Neurosurgery"},{"issue":"11","key":"bib19-20251027","first-page":"e1887","article-title":"Improving C1-C2 complex fusion rates: an alternate approach","volume":"9","author":"Ghostine","year":"2017","journal-title":"Cureus"},{"issue":"3","key":"bib20-20251027","first-page":"e1074","article-title":"C2 and greater occipital nerve: the anatomic and functional implications in spinal surgery","volume":"9","author":"Janjua","year":"2017","journal-title":"Cureus"}],"container-title":["Operative Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ons\/advance-article-pdf\/doi\/10.1093\/ons\/opaa336\/34672959\/opaa336.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opaa336","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:03:09Z","timestamp":1786122189000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opaa336"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,2]]},"references-count":20,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.1093\/ons\/opaa336","relation":{},"ISSN":["2332-4252","2332-4260"],"issn-type":[{"value":"2332-4252","type":"print"},{"value":"2332-4260","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,2]]},"assertion":[{"value":"2020-05-13","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-08-10","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}