Posterior C1-C2 transarticular screw fixation for Atlanto-axial instability.
The objective of this study was to reveal that the treatment of C1-C2 instability by transarticular C1-C2 screw fixation with bone graft has a better result than conventional sublaminar wiring with bone graft by Gallie's technique. This technique, proposed by Magerl and Semann in 1987, produces a rigid three points fixation resulting in maximal bone fusion rate and does not require an orthosis post-operatively. This technique is performed in patients with fractured lamina of C1 or in patients who need a laminectomy of C1 for spinal cord decompression. This study revealed 10 patients having C1-C2 instability who were operated on by transarticular C1-C2 screw fixation with bone graft. No complication was encountered. No screw and bone graft slipping were noted. The patients were improved clinically and the average follow-up period was 7.7 months. There were 2 cases which had previously been operated on for sublaminar wiring but the operation was unsuccessful because there was a fractured lamina of C1. Both patients were sent to Prasat Neurological Institute & Hospital for transarticular C1-C2 screw fixation. Another 2 cases were operated on for sublaminar wiring with bone graft. The follow-up X-ray of both cases disclosed a displacement of C1-C2. Lost of C1 lamina was found in one case and there was slipping of wire in another case, because of this the patients were re-explored for transarticular C1-C2 screw fixation with bone graft. The conclusion is, this technique of transarticular C1-C2 screw fixation, is the best surgical treatment for C1-C2 instability, in the hands of experienced surgeons with an excellent knowledge of anatomy.
Panjaisee
S
S
Department of Neurosurgery, Prasat Neurological Institute & Hospital, Bangkok, Thailand.
D000328:Adult; D000368:Aged; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D001863:Bone Screws; D016025:Bone Transplantation; D001864:Bone Wires; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016896:Treatment Outcome