title: [Surgical strategy for upper cervical vertebrae instability through the anterior approach].
abstract: OBJECTIVE
  To explore the choice and effect of internal fixation in treating upper cervical vertebrae instability through anterior approach.
  
  
  METHODS
  From March 2000 to September 2010,83 patients with upper cervical vertebrae instability were treated with internal fixation through anterior approach. There were 59 males and 24 females with a mean age of 42 years old (ranged, 20 to 68). Among these patients, 36 patients were treated with odontoid screw fixation, 16 patients with C1,2 transarticular screw fixation, 23 patients with C2,3 steel plate fixation, 5 patients with odontoid screw and transarticular screw fixation,2 patients with odontoid screw and C2.3 steel plate fixation, 1 patient with C1,2 transarticular screw and C2,3 steel plate fixation.
  
  
  RESULTS
  One patient with completely cervical vertebrae cord injury died of pulmonary infection after C1,2 transarticular screw fixation. Other patients were followed up from 8 to 36 months with an average of 15 months. Upper cervical vertebrae stability were restored without vertebral artery and spinal cord injury. Thirty-six patients were treated with odontoid screw fixation and 5 patients were treated with screw combined with transarticular screw fixation obtained bone union in the dentations without bone graft. Among the 16 patients treated with C1,2 transarticular screw fixation, 13 patients obtained bone union after bone graft; 1 patient died of pulmonary infection after surgery; 1 patient with comminuted odontoid fracture of type II C and atlantoaxial anterior dislocation did not obtain bone union after bone graft,but the fibrous healing was strong enough to maintain the atlantoaixal joint stability; 1 patient with obsolete atlantoaxial anterior dislocation were re-treated with Brooks stainless steel wire fixation and bone graft through posterior approach, and finally obtained bone union.
  
  
  CONCLUSIONS
  It could obtain satisfactory effects depending on the difference of cervical vertebrae instability to choose the correctly surgical method.
authors.affiliation: Department of Orthopaedics, Wuhan General Hospital of Guangzhou Command of PLA,Wuhan 430070, Hubei, China.
authors.forename: Wei-bing
authors.initials: WB
authors.lastname: Huang
authors.forename: Xian-hua
authors.initials: XH
authors.lastname: Cai
authors.forename: Zhuang-hong
authors.initials: ZH
authors.lastname: Chen
authors.forename: Ji-feng
authors.initials: JF
authors.lastname: Huang
authors.forename: Xi-ming
authors.initials: XM
authors.lastname: Liu
authors.forename: Shi-jun
authors.initials: SJ
authors.lastname: Wei
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D008875:Middle Aged