title: Atlantoaxial transarticular screw fixation: update on technique and outcomes in 269 patients.
abstract: BACKGROUND
  Transarticular screw (TAS) fixation is our preferred method for stable internal fixation of the atlantoaxial joint because of its excellent outcomes, versatility, and cost-effectiveness.
  
  
  OBJECTIVE
  In this article, we update our series of patients who have undergone TAS fixation, with attention to surgical technique, planning, complication avoidance, and anatomic suitability.
  
  
  METHODS
  We retrospectively reviewed 269 patients (150 women, 119 men; average age, 52.9 years; age range, 17-90 years) who underwent placement of at least 1 TAS. In total, 491 TASs were placed for stabilization necessitated by various pathologic conditions. The mean follow-up period was 15.7 months (range, 0-106 months).
  
  
  RESULTS
  Fusion was achieved in 99% of 198 patients monitored until fusion or nonunion requiring revision, or for 2 years. Forty-five patients had a complication, for a rate of 16.7%. Five early patients had vertebral artery injuries, 1 of which was bilateral and fatal. No recent patients had vertebral artery injuries. Other complications did not result in neurologic morbidity. Review of all atlantoaxial fusions by the senior author (R.I.A.) revealed that the TAS fixation technique could be successfully applied in 86.7% of sides considered. The main reasons for inapplicability were anatomic (recognized on preoperative planning) in 77% and abandonment secondary to concern about possible vertebral artery injury on the first side attempted in 13.8%.
  
  
  CONCLUSIONS
  The placement of TASs is safe and effective for stabilizing the atlantoaxial articulation. Refinements in technique, such as 3-dimensional stereotactic workstation for trajectory planning, have reduced the rate of serious complications. Clinical outcomes are excellent, with nearly 100% of patients achieving stable bony union.
authors.affiliation: Department of Neurosurgery, University of Utah, Salt Lake City, Utah 84132, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Finn
authors.forename: Ronald I
authors.initials: RI
authors.lastname: Apfelbaum
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001268:Atlanto-Axial Joint / Q000033:anatomy & histology / Q000601:surgery*; D001368:Axis, Cervical Vertebra / Q000033:anatomy & histology / Q000601:surgery; D001863:Bone Screws / Q000592:standards*; D001270:Cervical Atlas / Q000033:anatomy & histology / Q000601:surgery; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control; D007593:Joint Instability / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D038361:Neuronavigation / Q000379:methods; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000033:anatomy & histology / Q000601:surgery; D055815:Young Adult