{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T14:00:08Z","timestamp":1772892008255,"version":"3.50.1"},"reference-count":21,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Atlanto-occipital instability is commonly treated with posterior fixation. However, in patients with congenital or acquired factors, posterior fixation may not be possible. For these situations, a novel anterior atlanto-occipital transarticular screw (AATS) fixation technique has been introduced recently. However, biomechanical study of this technique is lacking. This study was designed to evaluate the biomechanical stability of AATS fixation for the atlanto-occipital joint and compare it with conventional posterior occipitocervical fixation (POCF).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>Six cadaveric specimens (occiput\u2013C4) were tested in four conditions, including intact, injury, injury + AATS, and injury + POCF states. A pure moment of 1.5 Nm was applied to specimens in flexion, extension, lateral bending, and axial rotation. The range of motion (ROM) and neutral zone (NZ) were calculated and compared from the occiput to C1.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>The AATS fixation constrained ROMs to 0.4\u00b0 in flexion (p &lt; 0.001), 0.4\u00b0 in extension (p &lt; 0.001), 1.0\u00b0 in lateral bending (p &lt; 0.001), and 0.7\u00b0 in axial rotation (p &lt; 0.001) when compared with the injury state. In all directions, there was no statistically significant difference observed in ROMs and NZs between AATS fixation and POCF (p &gt; 0.05).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>This study identified that the novel AATS fixation, as stand-alone anterior fixation, was equivalent to POCF in all directions. The results suggest that anterior transarticular screw fixation is a biomechanically effective salvage technique for posterior atlanto-occipital fixation, and may also serve as supplemental fixation.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2022.11.spine22564","type":"journal-article","created":{"date-parts":[[2022,12,2]],"date-time":"2022-12-02T10:04:32Z","timestamp":1669975472000},"page":"366-371","source":"Crossref","is-referenced-by-count":5,"title":["Anterior atlanto-occipital transarticular screw fixation: a biomechanical comparison with posterior fixation techniques"],"prefix":"10.3171","volume":"38","author":[{"given":"Panjie","family":"Xu","sequence":"first","affiliation":[{"name":"Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhiping","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hang","family":"Xiao","sequence":"additional","affiliation":[{"name":"Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junyu","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China;"},{"name":"Department of Orthopaedics and Traumatology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong City, Hong Kong; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qingan","family":"Zhu","sequence":"additional","affiliation":[{"name":"Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Ji","sequence":"additional","affiliation":[{"name":"Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China;"},{"name":"Department of Orthopaedics, Yunfu People\u2019s Hospital, Yunfu, Guangdong, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"J Neurosurg Spine","first-page":"381","article-title":"Atlantooccipital transarticular screw fixation for the treatment of traumatic occipitoatlantal dislocation Technical note","volume":"2","author":"Feiz-Erfan I","year":"2005","unstructured":"Feiz-Erfan I, Gonzalez LF, Dickman CA. 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Spine (Phila Pa 1976). 2003;28(3):E54\u2013E60."},{"issue":"5","key":"b5","series-title":"Eur Spine J","first-page":"1099","article-title":"Transoral anterior revision surgeries for basilar invagination with irreducible atlantoaxial dislocation after posterior decompression: a retrospective study of 30 cases","volume":"23","author":"Yang J","year":"2014","unstructured":"Yang J, Ma X, Xia H, Wu Z, Ai F, Yin Q. Transoral anterior revision surgeries for basilar invagination with irreducible atlantoaxial dislocation after posterior decompression: a retrospective study of 30 cases. Eur Spine J. 2014;23(5):1099\u20131108.24442275"},{"issue":"17","key":"b6","series-title":"Spine (Phila Pa 1976)","first-page":"E1010","article-title":"Anterior atlantooccipital transarticular screw fixation: a cadaveric study and description of a novel technique","volume":"44","author":"Ji W","year":"2019","unstructured":"Ji W, Xu X, Liu Q,  Anterior atlantooccipital transarticular screw fixation: a cadaveric study and description of a novel technique. Spine (Phila Pa 1976). 2019;44(17):E1010\u2013E1017.30946295"},{"key":"b7","series-title":"World Neurosurg","first-page":"e488","article-title":"Anterior atlanto-occipital transarticular screw fixation: a radiological evaluation","volume":"128","author":"Xu X","year":"2019","unstructured":"Xu X, Ji W, Liu X,  Anterior atlanto-occipital transarticular screw fixation: a radiological evaluation. World Neurosurg. 2019;128:e488\u2013e494.31048054"},{"issue":"2","key":"b8","series-title":"J Neurosurg Spine","first-page":"143","article-title":"Biomechanical comparison of occipitoatlantal screw fixation techniques","volume":"8","author":"Bambakidis NC","year":"2008","unstructured":"Bambakidis NC, Feiz-Erfan I, Horn EM,  Biomechanical comparison of occipitoatlantal screw fixation techniques. J Neurosurg Spine. 2008;8(2):143\u2013152.18248286"},{"issue":"7","key":"b9","series-title":"Int Orthop","first-page":"1239","article-title":"Injuries of the upper cervical spine-how can instability be identified?","volume":"44","author":"Liao S","year":"2020","unstructured":"Liao S, Jung MK, H\u00f6rnig L, Gr\u00fctzner PA, Kreinest M. Injuries of the upper cervical spine-how can instability be identified? 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Spine (Phila Pa 1976). 1991;16(3 suppl):S17\u2013S24.2028334"},{"issue":"11","key":"b12","series-title":"Spine J","first-page":"1538","article-title":"Percutaneous anterior occiput-to-axis screw fixation: technique aspects and case series","volume":"13","author":"Wu AM","year":"2013","unstructured":"Wu AM, Chi YL, Weng W, Xu HZ, Wang XY, Ni WF. Percutaneous anterior occiput-to-axis screw fixation: technique aspects and case series. Spine J. 2013;13(11):1538\u20131543.23932822"},{"issue":"3","key":"b13","series-title":"Spine (Phila Pa 1976)","first-page":"239","article-title":"Anterior occiput to axis screw fixation: part II: a biomechanical comparison with posterior fixation techniques","volume":"28","author":"Dvorak MF","year":"2003","unstructured":"Dvorak MF, Sekeramayi F, Zhu Q,  Anterior occiput to axis screw fixation: part II: a biomechanical comparison with posterior fixation techniques. Spine (Phila Pa 1976). 2003;28(3):239\u2013245."},{"issue":"12","key":"b14","series-title":"Spine (Phila Pa 1976)","first-page":"E696","article-title":"Biomechanical comparison of occiput-C1-C2 fixation techniques: C0-C1 transarticular screw and direct occiput condyle screw","volume":"37","author":"Takigawa T","year":"2012","unstructured":"Takigawa T, Simon P, Espinoza Or\u00edas AA,  Biomechanical comparison of occiput-C1-C2 fixation techniques: C0-C1 transarticular screw and direct occiput condyle screw. Spine (Phila Pa 1976). 2012;37(12):E696\u2013E701.22158063"},{"issue":"5","key":"b15","series-title":"Neurosurgery","first-page":"961","article-title":"Surgical treatment of occipitocervical instability","volume":"63","author":"Finn MA","year":"2008","unstructured":"Finn MA, Bishop FS, Dailey AT. Surgical treatment of occipitocervical instability. Neurosurgery. 2008;63(5):961\u2013969.19005387"},{"issue":"4","key":"b16","series-title":"Neurosurgery","first-page":"549","article-title":"Occipitocervical fixation: a single surgeon\u2019s experience with 120 patients","volume":"79","author":"Martinez-Del-Campo E","year":"2016","unstructured":"Martinez-Del-Campo E, Turner JD, Kalb S,  Occipitocervical fixation: a single surgeon\u2019s experience with 120 patients. Neurosurgery. 2016;79(4):549\u2013560.27428783"},{"issue":"2","key":"b17","series-title":"J Neurosurg Spine","first-page":"117","article-title":"Occipitocervical fusion with rigid internal fixation: long-term follow-up data in 69 patients","volume":"7","author":"Nockels RP","year":"2007","unstructured":"Nockels RP, Shaffrey CI, Kanter AS, Azeem S, York JE. Occipitocervical fusion with rigid internal fixation: long-term follow-up data in 69 patients. 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Spine (Phila Pa 1976). 1999;24(14):1425\u20131434.10423787"},{"issue":"6","key":"b20","series-title":"Neurosurgery","first-page":"1491","article-title":"Seven years of experience with C2 translaminar screw fixation: clinical series and review of the literature","volume":"68","author":"Dorward IG","year":"2011","unstructured":"Dorward IG, Wright NM. Seven years of experience with C2 translaminar screw fixation: clinical series and review of the literature. Neurosurgery. 2011;68(6):1491\u20131499.21346648"},{"issue":"3 suppl","key":"b21","series-title":"Neurosurgery","first-page":"87","article-title":"Comparison of contemporary occipitocervical instrumentation techniques with and without C1 lateral mass screws","volume":"61","author":"Wolfla CE","year":"2007","unstructured":"Wolfla CE, Salerno SA, Yoganandan N, Pintar FA. Comparison of contemporary occipitocervical instrumentation techniques with and without C1 lateral mass screws. 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