{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:30:58Z","timestamp":1786123858277,"version":"build-2736575974"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2017,8,10]],"date-time":"2017-08-10T00:00:00Z","timestamp":1502323200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/academic.oup.com\/journals\/pages\/about_us\/legal\/notices"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Operative Surg.","ONSURG"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Atlantoaxial instability, which can arise in the setting of trauma, degenerative diseases, and neoplasm, is often managed surgically with C1\u2013C2 arthrodesis. Classical C1\u2013C2 fusion techniques require placement of instrumentation in close proximity to the vertebral artery and C2 nerve root.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To report a novel C1\u2013C2 fusion technique that utilizes C2 translaminar screws and C1 sublaminar cables to decrease the risk of injury to the vertebral artery and C2 nerve root.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>To facilitate fixation to the atlas, while minimizing the risk of injury to the vertebral artery and to the C2 nerve root, we sought to determine the feasibility of using a soft cable around the C1 arch and affixing it to a rod connected to C2 laminar screws. We reviewed our experience in 3 patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>We used this technique in patients in whom we anticipated difficult C1 screw placement. Three patients were identified through a review of the senior author's cases. Atlantoaxial instability was associated with trauma in 2 patients and chronic degenerative changes in 1 patient. Common symptoms on presentation included pain and limited range of motion. All patients underwent C1\u2013C2 fusion with C2 translaminar screws with sublaminar cable harnessing of the posterior arch of C1. There were no reports of postoperative complications or hardware failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>We demonstrate a novel, technically straightforward approach for C1\u2013C2 fusion that minimizes risk to the vertebral artery and to the C2 nerve root, while still allowing for semirigid fixation in instances of both traumatic and chronic degenerative atlantoaxial instability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ons\/opx164","type":"journal-article","created":{"date-parts":[[2017,8,10]],"date-time":"2017-08-10T02:49:11Z","timestamp":1502333351000},"page":"647-653","source":"Crossref","is-referenced-by-count":7,"title":["Atlantoaxial Fusion Using C1 Sublaminar Cables and C2 Translaminar Screws"],"prefix":"10.1227","volume":"14","author":[{"given":"Alexandra M Giantini","family":"Larsen","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts"},{"name":"Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin L","family":"Grannan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts"},{"name":"Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M","family":"Koffie","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts"},{"name":"Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Val\u00e9ry","family":"Coumans","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts"},{"name":"Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,6]]},"reference":[{"issue":"2","key":"bib1-20231018","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1097\/00024720-200404000-00014","article-title":"Posterior C2 fixation using bilateral, crossing C2 laminar screws: case series and technical note","volume":"17","author":"Wright","year":"2004","journal-title":"J Spinal Disord Tech."},{"issue":"1","key":"bib2-20231018","doi-asserted-by":"crossref","first-page":"11-18, vii","DOI":"10.1016\/j.ocl.2011.09.004","article-title":"C1-C2 posterior fixation: indications, technique, and results","volume":"43","author":"Jacobson","year":"2012","journal-title":"Orthop Clin North Am."},{"issue":"6","key":"bib3-20231018","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1227\/NEU.0b013e318212a4d7","article-title":"Seven years of experience with C2 translaminar screw fixation: clinical series and review of the literature","volume":"68","author":"Dorward","year":"2011","journal-title":"Neurosurgery."},{"issue":"2","key":"bib4-20231018","doi-asserted-by":"crossref","first-page":"155","DOI":"10.3171\/spi.2005.2.2.0155","article-title":"Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications, and lessons learned in 191 adult patients","volume":"2","author":"Gluf","year":"2005","journal-title":"J Neurosurg Spine."},{"issue":"2","key":"bib5-20231018","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1097\/00000658-191002000-00004","article-title":"IV. 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