title: Clinical and radiological comparison of treatment of atlantoaxial instability by posterior C1-C2 transarticular screw fixation or C1 lateral mass-C2 pedicle screw fixation.
abstract: We compared the clinical and radiological results of posterior atlantoaxial fixation surgery using transarticular screws to those using a polyaxial screw-rod system in 55 patients with symptomatic atlantoaxial instability. Patients underwent posterior C1-C2 fixation: 28 patients (group 1) underwent C1-C2 transarticular screw fixation and 27 patients (group 2) underwent C1 lateral mass-C2 pedicle screw fixation. Patients were followed-up for at least 24 months. The clinical and radiological results were evaluated in the early postoperative period and at 3, 6, 12 and 24 months after surgery. Long-term postoperative stability and bone fusion were examined. After surgery, 93% of patients in group 1 and 96% of patients in group 2 were free of neck pain. The solid fusion rates were 82% for group 1 patients and 96% for group 2 patients at 12 months (p<0.092). In group 1, three patients showed fibrous union. Four patients had hardware failure due to a screw malposition (one in group 1) and pseudoarthrodesis (two in group 1 and one in group 2). One patient in group 1 had cerebrospinal fluid leakage. One patient in group 2 had occipital neuralgia. One vertebral artery injury occurred during the screw placement in group 1 and another in group 2 during the muscle dissection. C1-C2 transarticular screw fixation and C1 lateral mass-C2 pedicle screw fixation both produced excellent results for stabilization of the atlantoaxial complex, but the radiological outcome tended to be superior in C1 lateral mass-C2 pedicle screw fixation.
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea.
authors.forename: Sun-Ho
authors.initials: SH
authors.lastname: Lee
authors.forename: Eun Sang
authors.initials: ES
authors.lastname: Kim
authors.forename: Joo-Kyung
authors.initials: JK
authors.lastname: Sung
authors.forename: Yeun-Mook
authors.initials: YM
authors.lastname: Park
authors.forename: Whan
authors.initials: W
authors.lastname: Eoh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D001863:Bone Screws; D001270:Cervical Atlas / Q000000981:diagnostic imaging / Q000601:surgery; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009809:Odontoid Process / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult