title: Modified technique for C1-2 screw-rod fixation and fusion using autogenous bicortical iliac crest graft.
abstract: BACKGROUND
  Various techniques have been described for posterior atlantoaxial fusion. Sublaminar passage of the wire/cable is cumbersome with a risk of spinal cord injury. Packing morselized bone grafts into the C1-2 facet joints may be difficult and it may cause massive bleeding and neuropathic pain or posterior scalp numbness postoperatively. We introduce a modified method by using C1-2 screw-rod fixation (SRF) to compress a structural iliac bone graft between the posterior elements of C1 and C2 without supplemental wiring construct.
  
  
  METHODS
  From December 2006 to May 2009, 35 consecutive patients with atlantoaxial instability treated by this method were reviewed retrospectively. Clinical and radiographic history was recorded. Patients with neck pain had relieved significantly after surgery and the neurologic status was also improved greatly. Thirty-three (94.3%) patients gained bony fusion at 3 months postoperatively. No vertebral artery and spinal cord injuries were noted. There was no instrumentation failure during the observation period.
  
  
  CONCLUSIONS
  We conclude that the C1-2 SRF with construct-compression structural bone grafting can be used for C1-2 fusion with relatively simple performance and less time-consuming in selected cases.
authors.affiliation: Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, 415 Fengyang Road, Huangpu, Shanghai, 200003, People's Republic of China. nibin99@sohu.com
authors.forename: Bin
authors.initials: B
authors.lastname: Ni
authors.forename: Fengjin
authors.initials: F
authors.lastname: Zhou
authors.forename: Qunfeng
authors.initials: Q
authors.lastname: Guo
authors.forename: Songkai
authors.initials: S
authors.lastname: Li
authors.forename: Xiang
authors.initials: X
authors.lastname: Guo
authors.forename: Ning
authors.initials: N
authors.lastname: Xie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D001368:Axis, Cervical Vertebra / Q000000981:diagnostic imaging / Q000601:surgery; D001858:Bone Nails / Q000592:standards; D001863:Bone Screws / Q000592:standards; D016025:Bone Transplantation / Q000295:instrumentation / Q000379:methods*; D001270:Cervical Atlas / Q000000981:diagnostic imaging / Q000601:surgery; D002648:Child; D005260:Female; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D055815:Young Adult