Advanced Posterior Strategies for Upper Cervical Spine Surgery
Bodon Gergely
Theoretical and Translational Medicine Division
Dr. Kellermayer Miklós
SE Sebészeti, Transzplantációs és Gasztroenterológiai Klinika tanterme
2026-03-09 10:00:00
Clinical application of basic science results
Dr. Vásárhelyi Barna
Dr. Ruttkay Tamás
Dr. Viola Árpád
Dr. Farkas József
Dr. Harsányi László
Dr. Barkai László József
Dr. Szűcs Zoltán
This thesis is based on two anatomy based feasibility studies dealing with two surgical approaches to the upper cervical spine: a minimally invasive approach for atlantoaxial fusion and the posterolateral extradural suboccipital approach to the retroodontoid region. Atlantoaxial fusion is performed in cases of instability caused by congenital anomalies, trauma, tumors, degenerative diseases, infections or rheumatoid arthritis. The posterolateral extradural suboccipital approach, offer access to the epidural space, retroodontoid region and the odontoid process.
A deep understanding of the anatomy of the craniocervical junction is essential for safe surgery. This thesis deals extensively with the bony, ligamentous, neural and vascular anatomy of the region. For the anatomic part of the studies, we used dry bone specimens, formalin or Thiel fixed specimens. The surgical approach was tested on fresh cadavers.
The first study evaluates a minimally invasive muscle-splitting approach for posterior C1-C2 fusion, assessing its feasibility for precise screw placement with reduced muscle disruption. The second study examines the extent of bone removal needed for a posterior far-lateral suboccipital approach to reach the retroodontoid region and the odontoid process.
Direct visualization of the bony landmarks and the screw starting points for screw placement into the C1 lateral mass and C2 pars interaricularis was feasible using the minimally invasive muscle-splitting approach.
The far-lateral suboccipital approach to the retro-odontoid region study focused on quantifying the extent of bone removal needed to optimize the surgical exposure. Stepwise resection of the C1 posterior arch and lateral mass significantly increased access to the retro-odontoid space. The study identified three key stages of bone removal. The surgical window without bone removal could be increased from 6mm * 10mm to a maximum of 10mm * 17mm after the complete removal of the posterior hemi arch and the medial aspect of the lateral mass.
This research supports minimally invasive techniques to optimize surgical outcomes and refine surgical techniques to the posterior upper cervical spine.
