title: C1-2 posterior arthrodesis technique with a left segmental and right transarticular fixation. A hybrid novel (Kotil) technique.
abstract: BACKGROUND
  The most commonly used techniques for C1-C2 posterior arthrodesis are Goel and Magerl fixation techniques. Due to the anatomical variations of the region, the prior determination of the surgical technique might be hard. Right side Magerl, left side Goel's C1-C2 posterior arthrodesis case is presented as a new surgical combination technique used due to anatomical difficulties.
  
  
  METHODS
  Posterior C1-C2 arthrodesis operation was indicated for a 56-year-old female patient for the treatment of atlanto-axial subluxation caused by os odontoideum. First it was fixed from the nondominant arterial side (right vertebral artery) with Magerl (transarticular) technique. The left side was not suitable for the anatomical transarticular fixation, and the contralateral Goel fixation technique (segmental) was performed. Eventually, right side transarticular left side segmental fixation techniques were combined in one patient for the first time and C1-C2 fusion combination technique was presented.
  
  
  RESULTS
  Both Goel and Magerl techniques of C1-C2 posterior fusion techniques were successfully used simultaneously. The operation was initiated with Magerl technique with one screw on the nondominant side. The contralateral side was not suitable for Magerl technique therefore we changed to Goel's technique. Although, fluoroscopy was used 3 times as much during the introduction of the Drill with Magerl technique, twice as much operative time was spent during hemostasis and bleeding, preparation of the C1 entry point, and the reconstruction of polyaxial screws for Goel technique. No neurovascular complications were occurred during both procedures.
  
  
  CONCLUSIONS
  Combination of two C1-C2 posterior fusion techniques, Goel and Magerl, in suitable cases caused by anatomical or other reasons appears to be an alternative surgical procedure that protects the patient from complications. For a collection of better data, other studies that include large numbers of patients with high evidential value should be conducted.
authors.affiliation: Department of Neurosurgery, T.C. Istanbul Arel University, Istanbul, Tepekent/Turkey.
authors.forename: Kadir
authors.initials: K
authors.lastname: Kotil
authors.affiliation: Department of Neurosurgery, T.C. Istanbul Arel University, Istanbul, Tepekent/Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Muslumanoglu
keywords: C1-C2 posterior arthrodesis; Kotil technique; novel technique; segmental fixation; transarticular fixation