title: Anterior transarticular screw fixation for atlantoaxial arthrodesis: A report of two cases.
abstract: The sequelae of atlantoaxial instability (AAI) range from axial neck pain to life-threatening neurologic injury. Instrumentation and fusion of the C1-2 joint is often indicated in the setting of clinical or biomechanical instability. This is the first clinical report of anterior Smith-Robinson C1-2 transarticular screw (TAS) fixation for AAI. The first patient presented with ischemic brain tissue secondary to post-traumatic C1-2 segment instability from a MVC 7 years prior to presentation. The second patient presented with a 3 year history of persistent right-sided neck and upper scalp pain. Both were treated with transarticular C1-2 fusion through decortication of the atlantoaxial facet joints and TAS fixation via the anterior Smith-Robinson approach. At 16 months follow-up, the first patient maintained painless range of motion of the cervical spine and denied sensorimotor deficits. The second patient reported 90% improvement in her pre-operative symptoms of neck pain and paresthesia. Anterior Smith-Robinson C1-2 TAS fixation provides a useful alternative to the posterior Goel and Magerl techniques for C1-2 stabilization and fusion.
authors.affiliation: Tufts University School of Medicine, Boston, MA 02111, USA.
authors.forename: C S
authors.initials: CS
authors.lastname: Carrier
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, New York 10021, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Sama
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, New York 10021, USA.
authors.forename: F P
authors.initials: FP
authors.lastname: Girardi
authors.affiliation: Department of Orthopedic Surgery, Hospital for Special Surgery, New York 10021, USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Lebl
keywords: Anterior approach; C1-C2 fixation; atlantoaxial instability; transarticular screw fixation
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