[New surgical technique for atlanto-axial instability: C1-2 dorsal fixation with the screw-rod system].
OBJECTIVE
It is still challenging to perform the operation for the instability of the C1-C2 junction because of the limited cases, unique anatomical landmarks, the potential or real injury of the neurological elements, the serious clinical state and the special technical and human background is demanding. With the aim of minimalize the risk the following method provide sufficient stability, successful and simple.


METHODS
The authors used the dorsally implanted screw-rod systems for operating 34 patient with C1-2 instability resulting clinically signs and symptoms. Depending the anatomical landmarks and the technical possibilities, the screw insertion method and the reinforced wire cable use was selected. Meaning the indication of the surgical treatment, the neurological signs, compromise of the spinal canal and pain resisting the conservative treatment was presented.


RESULTS
The C1-2 dorsally fixation was performed to 34 patients. Both sided lateral mass screw was inserted in 30 cases (88.3%). Because of the anatomical landmarks in four cases (11.7%) the one sided screwing was made by the Magerl technique. Pure bone quality detecting intraoperatively demand reinforcement with titanium cables for three cases (8.8%). Pain resulted of instability was recovered. The clinical and neurorariological follow-up present perfect result for 26 patients (76%), good result for six patients, there was respectable result for two patients. Most of the patients, 31 cases (91%) were satisfied, and three patients (9%) consider their condition acceptable.


CONCLUSIONS
Performing the represened techique, the risk and the time of the operation was decreased reducing the rate of the complications. The method providing full stability resulted immediate axial painless, no outer support and early mobilization is possibile. Summarizing this technique is safe, reliable and cost effective.
Lipóth
László
L
Allami Egészségügyi Központ, Idegsebészeti Osztály, Budapest.
Banczerowski
Péter
P
Veres
Róbert
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D001863:Bone Screws; D002648:Child; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D013123:Spinal Fusion / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult