Posterior Atlantoaxial Fusion Using C1 Lateral Mass and C2 Pedicle by Polyaxial Screw in Atlantoaxial Instability

O. Rezaee, R. Salar, R. Jabari, A. Shams Akhtari, M. Taghizadeh

.
Neurosugery Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

DOI: 10.4236/ojmn.2014.43027                

Abstract

Objective: The aim of this study is to evaluate clinical and radiological outcomes in subjects of atlantoaxial instability which were operated using C1 lateral mass and C2 pedicle screw (Harmes technique). Materials and Methods: Twenty patients with atlantoaxial instability were scheduled at our clinic for atlantoaxial fusion using polyaxial C1 lateral mass and C2 pedicle screw between January 2008 and March 2014. Results: Trauma was the most common cause of atlantoaxial instability, seen in 18 (90%) patients. Modes of trauma were road traffic accident (75%) and falling (15%). Osteoarthritis was observed in 10% of cases. Patients were followed up with radiographs and clinical examinations. Satisfactory screw placement and reduction were achieved in all patients with the average union time of 3.5 months. There were no implant failures, nonunions, vertebral artery injuries or C2 nerve root injuries. Only, surgical site infections occur in 20% of cases that are improved with medical treatment. Conclusions: C1 lateral mass and C2 pedicle polyaxial screw fixation is an effective technique for the fusion of the atlantoaxial complex. It provides the highest fusion rates without any risk of vertebral injury.

Keywords

Atlantoaxial Instability, Polyaxial Screw, C1 Lateral Mass, C2 Pedicle, Fusion

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Califianeller, T., Yilmaz, C., Ozdmer, O. and Caner, H. (2008) Posterior Atlanto Lateral Mass Fixation Technique with Polyaxial Screw and Rod Fixation System. Turkish Neurosurgery, 18, 142-148.
[2]	Yoon, S.M., Baek, J.W. and Kim, D.H. (2012) Posterior Atlantoaxial Fusion with C1 Lateral Mass Screw and C2 Pedicle Screw Supplemented with Miniplate Fixation for Interlaminar Fusion: A Preliminary Report. Journal of Korean Neurosurgical Society, 52, 120-125. http://dx.doi.org/10.3340/jkns.2012.52.2.120
[3]	Bahadur, R., Goyal, T., Dhatt, S.S. and Tripathy, S.K. (2010) Transarticular Screw Fixation for Atlantoaxial Instability-Modified Margels Technique in 38 Patients. Journal of Orthopaedic Surgery and Research, 5, 1-8. http://dx.doi.org/10.1186/1749-799X-5-87
[4]	Dickman, C.A., Sonntag, V.K., Papadopoulos, S.M. and Hadley, M.N. (1991) The Interspinous Method of Posterior Atlantoaxial Arthrodesis. Journal of Neurosurgery, 74, 190-198. http://dx.doi.org/10.3171/jns.1991.74.2.0190
[5]	Gallie, W.E. (1939) Fracture and Dislocations of the Cervical Spine. The American Journal of Surgery, 46, 495-499. http://dx.doi.org/10.1016/S0002-9610(39)90309-0
[6]	Goel, A., Desai, K. and Mazumdar, D. (2002) Atlantoaxial Fixation Using Plate and Screw Method: A Report of 160 Treated Patients. Neurosurgery, 51, 1351-1356.
[7]	Kwan, M.K., Chan, C.Y.W., Kwan, T.C.C., Gash, Y.N. and Saw, L.B. (2010) Safety Issues and Neurological Improvement Following C1-C2 Fusion Using C1 Lateral Mass and C2 Pedicle Screw in Atlantoaxial Instability. Malaysian Orthopaedic Journal, 4, 17-22. http://dx.doi.org/10.5704/MOJ.1007.003
[8]	Margel, F.S.P. (1987) Stable Posterior Fusion of the Atlas and Axis by Transarticular Screw Fixation. In: Kehr, P. and Weidner, A., Eds., Cervicale Spine I, Springer Wien Berlin Heidelberg, New York, 322-327.
[9]	Reilly, T.M., Sasso, R.C. and Hall, P.V. (2003) Atlantoaxial Stabilization: Clinical Comparison of Posterior Cervical Wiring Technique with Transarticular Screw Fixation. Journal of Spinal Disorders Techniques, 16, 248-253. http://dx.doi.org/10.1097/00024720-200306000-00004
[10]	Gunnarsson, T., Massicotte, E.M., Govender, P.V., Raja Rampersaud, Y. and Fehlings, M.G. (2007) The Use of C1 Lateral Mass Screws in Complex Cervical Spine Surgery: Indications, Techniques, and Outcome in a Prospective Consecutive Series of 25 Cases. Journal of Spinal Disorders Techniques, 20, 308-316. http://dx.doi.org/10.1097/01.bsd.0000211291.21766.4d
[11]	Mummaneni, P.V. and Haid, R.W. (2005) Atlantoaxial Fixation: Overview of All Techniques. Neurology India, 53, 409-415. http://dx.doi.org/10.4103/0028-3886.22606
[12]	Frankel, H.L., Hancock, D.O., Hyslop, G., Melzak, J., Michaelis, L.S., Ungar, G.H., et al. (1969) The Value of Postural Reduction in the Initial Management of Closed Injuries of the Spine with Paraplegia and Tetraplegia. I. Paraplegia, 7, 179-192. http://dx.doi.org/10.1038/sc.1969.30
[13]	Sharma, M.K., Chichanovskaya, L.V., Shlemsky, V.A. and Petrukhina, E. (2013) A Comprehensive Study of Outcome after Lumbar Discectomy for Lumbar Degenerative Spine Disease at 6 Months Post-Operative Period. The Open Neurosurgery Journal, 6, 1-5. http://dx.doi.org/10.2174/1876529701306010001
[14]	Pang, D. and Li, V. (2004) Atlantoaxial Rotator Fixation: Part 1—Biomechanics of Normal Rotation at Atlantoaxial Joint in Children. Neurosurgery, 55, 614-625. http://dx.doi.org/10.1227/01.NEU.0000134386.31806.A6
[15]	Hanimoglu, H., Hancl, L., Kaynar, M.Y. and Hancl, M. (2009) Bilateral C1-C2 Claw for Atlantoaxial Instability. Turkish Neurosurgery, 19, 345-348.
[16]	Brooks, A.L. and Jenkins, E.B. (1978) Atlanto-Axial Arthrodesis by the Wedge Compression Method. Journal of Bone and Joint Surgery, 60, 279-284.
[17]	Saito, R., Hase, H., Mikami, Y., Tsuji, Y., Ikeda, T., Osawa, T., et al. (2006) Clinical Study of a Modified Brooks Technique for Atlanto-Axial Subluxation Using Polyethylene Tape. Journal of Spinal Disorders Techniques, 19, 11-17. http://dx.doi.org/10.1097/01.bsd.0000173839.51476.63
[18]	Grob, D. and Magerl, F. (1987) Surgical Stabilization of C1 and C2 Fractures. Orthopade, 16, 46-54.
[19]	Goel, A. and Laheri, V. (1994) Plate and Screw Fixation for Atlantoaxial Subluxation. Acta Neurochirurgica (Wien), 129, 47-53. http://dx.doi.org/10.1007/BF01400872