Posterior transarticular screw fixation for chronic atlanto-axial instability.
Treatment for chronic atlanto-axial instability remains problematic despite recent innovations in new surgical techniques and instrumentation. Our team reviewed a series of 23 cases of patients with chronic atlanto-axial instability who underwent posterior transarticular screw fixation operations between May 1998 and September 2002. Etiologies of these patients included failed prior surgery, rheumatoid arthritis, congenital anomalies and old odontoid fractures. The clinical presentations were nuchal pain and cervical myelopathy or radiculopathy, with sensory and/or motor deficits that persisted for more than 3 months. We routinely used external reduction to realign the C1-C2 axis prior to operating, and operated on patients using halo-vest fixation. After surgery, the halo-vest was replaced by a collar. In the post-operative follow-up, 22 of the 23 patients (96%) were found to have achieved solid, bony or fibrous union of the C1-C2 axis. Eleven of the 14 (79%) patients with pre-operative neck pain experienced immediate relief or significant improvement. Thirteen of the 20 patients (65%) with myelo-radiculopathy demonstrated improvement of previous motor deficits. Major morbidity included a vertebral artery (VA) injury and a malpositioned screw. No cases of mortality or neurological complications occurred in this series. Posterior transarticular C1-C2 screw fixation results in a high fusion rate without the additional need for rigid external immobilization. It allows good neurological recovery in cases of chronic atlanto-axial instability. Judicious pre-surgical planning and meticulous operative technique may avoid neurological complications and vertebral artery injury.
Liang
Muh-Lii
ML
Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Huang
Ming-Chao
MC
Cheng
Henrich
H
Huang
Wen-Cheng
WC
Yen
Yu-Shu
YS
Shao
Kuo-Ning
KN
Huang
Chien-I
CI
Shih
Yang-Hsin
YH
Lee
Liang-Shong
LS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001268:Atlanto-Axial Joint / Q000601:surgery*; D001863:Bone Screws; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods*