title: Atlantoaxial transarticular screw fixation and posterior fusion using polyester cable: a 10-year experience.
abstract: OBJECTIVE
  To retrospective review the clinical outcomes of the modified operative technique using a polyester suture material (Ethibond* Excel) for atlantoaxial transarticular screw fixation and posterior fusion.
  
  
  METHODS
  The retrospective reviews were conducted from 2002 to 2012. The patient's medical record reviews included demographic data, cause of atlantoaxial instability, orthopedic and surgical history, clinical presentation, radiographic finding including plain radiography, complications, operative detail, and outcome of treatment. Fusion of C1-C2 was defined as either graft consolidation or absence of C1-C2 movement on lateral flexion-extension radiograph.
  
  
  RESULTS
  Twenty-three patients demonstrated clinical and radiographic evidence of atlantoaxial instability (13 men and 10 women, with a mean age of 42 years). Majority of atlantoaxial instability was caused by trauma. Most common clinical symptom was neck pain with or without cervical myelopathy. Bilateral screws were placed in 18 of the 23 patients. Five patients underwent placement of unilateral screws. The 13 patients were inserted by screws with diameter 4.0 mm. The means screw length was 40.33 mm. The means of operative time and estimated blood loss were 3.6 h and 234 ml, respectively. The mean of follow-up duration was 18 months. All 41 screws were positioned satisfactorily in C1 lateral mass. All 23 patients achieved fusion (100% fusion rate). After a period of follow-up, 9 of the 10 neurological deficit patients had completely recovered.
  
  
  CONCLUSIONS
  We concluded that the atlantoaxial transarticular screw fixation and posterior fusion using polyester cable can be used for C1-2 fusion with a high fusion rate and less complications in various cases.
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Prannok road, Bangkoknoi, Bangkok 10700, Thailand. werasak.sut@mahidol.ac.th
authors.forename: Werasak
authors.initials: W
authors.lastname: Sutipornpalangkul
authors.forename: Surin
authors.initials: S
authors.lastname: Thanapipatsiri
mesh_terms: D000328:Adult; D001268:Atlanto-Axial Joint / Q000601:surgery*; D001863:Bone Screws; D005260:Female; D006801:Humans; D016268:Internal Fixators; D007593:Joint Instability / Q000601:surgery; D008297:Male; D011093:Polyethylene Terephthalates; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome
chemical_list: C014534:Ethibond; D011093:Polyethylene Terephthalates