Atlantoaxial Stabilization: Clinical Comparison of Posterior Cervical Wiring Technique With Transarticular Screw Fixation

Abstract

Symptomatic atlantoaxial instability requires atlantoaxial stabilization. In this study the authors compared clinical, radiographic, and cervical outcome questionnaire results in 67 such patients who underwent 71 separate procedures. Thirty-eight patients had traditional posterior C1-C2 cervical wiring and halo-vest immobilization (group 1), whereas 33 were alternatively managed with transarticular screw fixation without rigid external immobilization (group 2). Mean follow-up in group 1 was 53.2 months and mean follow-up in group 2 was 41.0 months. Radiographic evaluation demonstrated seven pseudoarthroses and four fibrous unions in group 1, with six patients subsequently undergoing reoperation. There were no pseudoarthroses and two fibrous unions in the transarticular screw group (p = 0.015). In those that fused, >2-mm displacement occurred in six of the group 1 patients (p = 0.027). There was a trend toward fewer complications in group 2 patients (p = 0.085) with four complications, as compared with 12 complications in group 1, including a 21% incidence of halo-vest-related complications. These results demonstrate the significant benefits of transarticular screw fixation over posterior cervical wiring techniques in the management of atlantoaxial instability.

Posterior Instrumentation Surgery for Craniocervical Junction Instabilities: an Update

“…[28][29][30]51,55,84) Posterior atlantoaxial fixation has been a treatment of choice for type II and some type III odontoid fractures, the most common upper cervical spine fracture. 33,34,52,67) Spine surgeons from North America have favored a posterior surgical approach for fixation of type II and III odontoid fractures. 8,11,14,58,87) In contrast, surgeons from Europe and Japan frequently perform and prefer the anterior odontoid screw fixation technique.…”

Methods of Segmental Screw Fixation of Axis: A Cadaveric and Surgical Study

“…4,6,8 However, they had lower fusion rates, necessitates intact posterior vertebral components and postoperative immobilization. 6,16,23 Transpedicular screw fixation was first pioneered in 1964 by Leconte and followed by Borne et al for treatment of traumatic spondylolisthesis (hangman ' s fracture) of axis. 3,11 Trans pars interarticularis screw is a modification of Magerl C1-C2 transarticular screw, 13 which is a non segmental fixation technique between C1-C2 requiring perfect preinsertion alignment of C1-2 joint for its safe placement.…”

C1 lateral mass screws for posterior segmental stabilization of the upper cervical spine and a new method of three-point rigid fixation of the C1-C2 complex

“…Any venous bleeding was easily stopped using hemostatic agents and gentle packing. We modified Brooks quite often did not provide sufficient rigidity and as a result nonunions rates were high 6,[8][9][10] . More recently, studies on biomechanics of the atlantoaxial joint have demonstrated that its kinematics is indeed complex and there is intervertebral coupled motion at the C1-C2 joints 11 .…”

“…Although some may argue that the transarticular screws combined with a wiring technique provide an excellent three-point fixation technique 1,2,12,14 , the passage of sublaminar wires is not without hazards 10,17 . This might be especially true for those patients in which there is a non-reducible C1-C2 subluxation and/or reduced space available for the cord.…”

“…This might be especially true for those patients in which there is a non-reducible C1-C2 subluxation and/or reduced space available for the cord. Several authors have described worsening of a preexisting myelopathy as a complication of passing sublaminar wires, particularly in patients with rheumatoid arthritis and/or os odontoideum 6,10 . For that reason, they recommended transarticular screws when stabilizing the C1-C2 complex in the presence of an os odontoideum, avoiding posterior wiring 6 .…”