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Clinical Study| Volume 16, ISSUE 12, P1592-1594, December 2009

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Posterior C1 lateral mass and C2 pedicle screw internal fixation for atlantoaxial instability

      Abstract

      From January 1999 to May 2005, 25 patients (15 males and 10 females; age range, 18–70 years; mean, 42 years) who demonstrated clinical and radiographic evidence of atlantoaxial instability underwent C1 lateral mass and C2 pedicle screw internal fixation with or without fusion at our Orthopedic Unit. The cause of instability was: 13 patients, traumatic fracture; three patients, rheumatoid arthritis; two patients, rotatory subluxation; two patients, congenital malformation; five patients, failed previous surgery. A mean follow-up of 16 months was obtained (range, 4–48 months). Mean operative time was 107 minutes (range, 80–141 minutes). No patient received a blood transfusion. No patient experienced worsening neurological function related to the procedure postoperatively or at follow-up. No other postoperative complication was observed. All patients were relieved from axial pain. Screw placement and reduction were achieved satisfactorily in all patients. Each patient showed evidence of solid fusion after 12 months by plain radiography and dynamic films. During follow-up, no complications were observed related to the bone graft or the screw rod. We suggest that C1 lateral mass and C2 pedicle screw internal fixation is a reliable method to repair atlantoaxial instability.

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      References

        • Reilly T.M.
        • Sasso R.C.
        • Hall P.V.
        Atlantoaxial stabilization: clinical comparison of posterior cervical wiring technique with transarticular screw fixation.
        J Spinal Disord Tech. 2003; 16: 248-253
        • Madawi A.A.
        • Casey A.T.
        • Solanki G.A.
        • et al.
        Radiological and anatomical evaluation of the atlantoaxial transarticular screw fixation technique.
        J Neurosurg. 1997; 86: 961-968
        • Harms J.
        • Melcher R.P.
        Posterior C1–C2 fusion with polyaxial screw and rod fixation.
        Spine. 2001; 26: 2467-2471
        • Stulik J.
        • Vyskocil T.
        • Sebesta P.
        • et al.
        Atlantoaxial fixation using the polyaxial screw-rod system.
        Eur Spine J. 2007; 16: 479-484
        • Dickman C.A.
        • Crawford N.R.
        • Paramore C.G.
        Biomechanical characteristics of C1–C2 cable fixations.
        J Neurosurg. 1996; 85: 316-322
        • Coyne T.J.
        • Fehlings M.G.
        • Wallace M.C.
        • et al.
        C1–C2 posterior cervical fusion: Long-term evaluation of results and efficacy.
        Neurosurgery. 1995; 37: 688-692
        • Farey I.D.
        • Nadkarni S.
        • Smith N.
        Modified Gallie technique versus transarticular screw fixation in C1–C2 fusion.
        Clin Orthop. 1999; : 126-135
        • Goel A.
        • Achawal S.
        The surgical treatment of Chiari malformation association with atlantoaxial dislocation.
        Br J Neurosurg. 1995; 9: 67-72
        • Melcher R.P.
        • Puttlitz C.M.
        • Kleinstueck F.S.
        • et al.
        Biomechanical testing of atlantoaxial fixation techniques.
        Spine. 2002; 27: 2435-2440
        • Currier B.
        • Todd L.
        • Maus T.
        • et al.
        Anatomic relationship of the internal carotid artery to the C1 vertebra: A case report of cervical reconstruction for chordoma and pilot study to assess the risk of screw fixation of the atlas.
        Spine. 2003; 28: E461-E467
        • Hong J.T.
        • Lee S.W.
        • Son B.C.
        • et al.
        Hypoglossal nerve palsy after posterior screw placement on the C1-lateral mass. Case report.
        J Neurosurg Spine. 2006; 5: 83-85