title: Reduction and arthrodesis with sublaminar spiral silk in atlantoaxial joint instability.
abstract: OBJECTIVE
  The aim of this study was to evaluate the clinical and radiologic results of the use of thick spiral silk knotting instead of sublaminar wiring for C1-C2 arthrodesis in patients with atlantoaxial instability.
  
  
  METHODS
  We retrospectively evaluated 16 patients (10 females, 6 males; mean age: 43.4 years; mean follow-up: 34 months) with atlantoaxial instability who underwent C1-C2 fusion by reduction and sublaminar spiral silk knotting. All patients underwent open reduction, bounding both laminae with thick spiral silk instead of wiring and arthrodesis with autografting. Reduction rates, screw position and fusion rates were evaluated using computed tomography.
  
  
  RESULTS
  Preoperative mean atlantodental interval (ADI) was 8 (range: 6 to 11) mm and postoperative ADI was 2.1 (range: 0.5 to 2.5) mm. There was no dural or spinal cord injury. Complete reduction was observed in all cases. Fusion was unsuccessful in 1 case (6.25%). Postoperative mean flexion ADI was 10 mm and mean extension ADI was 1 mm. Graft separation between C1-C2 was observed in slice tomographic examination in one patient. Malposition was observed in 2 screws (4%).
  
  
  CONCLUSIONS
  The sublaminar silk knotting technique appears to provide safe anatomical reduction. As this method is cheap and simple and does not require extra implantation, loosen, create neurologic compromise or cause radiologic crowding, it can be considered an alternative surgical technique to sublaminar wiring.
authors.affiliation: Department of Physiotherapy and Rehabilitation, School of Health Sciences, Istanbul Arel University, İstanbul, Turkey. kadirkotil@arel.edu.tr.
authors.forename: Kadir
authors.initials: K
authors.lastname: Kotil
authors.affiliation: Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey.
authors.forename: Mustafa Gökhan
authors.initials: MG
authors.lastname: Bilgili
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey.
authors.forename: Selim
authors.initials: S
authors.lastname: Kayacı
mesh_terms: D000293:Adolescent; D000328:Adult; D001174:Arthrodesis / Q000379:methods*; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D001863:Bone Screws; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D047011:Silk; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D047011:Silk