title: Radiographic evaluation of the technique for C1 lateral mass and C2 pedicle screw fixation in three hundred nineteen cases.
abstract: METHODS
  Retrospective radiographic study of the technique for C1 lateral mass screw (C1LMS) and C2 pedicle screw (C2PS) fixation.
  
  
  OBJECTIVE
  To evaluate (1) the accuracy of the C1LMS and C2PS placement; (2) the fusion rate between C1 and C2; (3) the risk for vertebral artery (VA) injury.
  
  
  BACKGROUND
  C1LMS and C2PS fixation is widely used when treating atlantoaxial instability. Several authors have reported their experience focusing on the technical outcomes, with many reporting fusion rates near 100%. However, most of them are relatively small series, and many have applied only plain postoperative radiographs instead of computed tomography (CT). Thus, we feel that the accuracy of C1LMS and C2PS placement has not been fully analyzed, as well as the anatomic relationship between the VA and the screws.
  
  
  METHODS
  Between December 2000 and September 2008, the fusion status and accuracy of the screws were evaluated on the postoperative reconstructive CT of 319 patients with atlantoaxial instability. Cases with malpositioned screws underwent CT angiography or magnetic resonance angiography after surgery, to evaluate potential VA injury.
  
  
  RESULTS
  C1LMS of 95.5% and C2PS of 92.8% were found to be in a "good" position. After 2007, six cases had malpositioned screws, which were all in the "out" or "down" area of the C2 pedicle. Five cases underwent CT angiography and 1 had magnetic resonance angiography to evaluate potential VA injury. No occlusion, associated aneurysm or fistula of the VA was found. All cases (100%) achieved solid fusion between C1 and C2.
  
  
  CONCLUSIONS
  C1LMS of 95.5% and C2PS of 92.8% were confirmed to be in good position. None of the screws including the malpositioned caused VA injury, clinically or radiographically. The technique for C1LMS and C2PS fixation appears to be safe and effective.
authors.affiliation: Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
authors.forename: Shenglin
authors.initials: S
authors.lastname: Wang
authors.forename: Chao
authors.initials: C
authors.lastname: Wang
authors.forename: Kirkham B
authors.initials: KB
authors.lastname: Wood
authors.forename: Ming
authors.initials: M
authors.lastname: Yan
authors.forename: Haitao
authors.initials: H
authors.lastname: Zhou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002681:China; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000209:etiology; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000293:injuries; D055815:Young Adult