title: Posterior atlantoaxial fixation: a review of all techniques.
abstract: BACKGROUND
  Posterior atlantoaxial fixation is an effective treatment for atlantoaxial instability. Great advancements on posterior atlantoaxial fixation techniques have been made in the past decades. However, there is no article reviewing all the posterior atlantoaxial fixation techniques yet.
  
  
  OBJECTIVE
  The aim was to review the evolution and advancements of posterior atlantoaxial fixation.
  
  
  METHODS
  This was a literature review.
  
  
  METHODS
  The application of all posterior fixation techniques in atlantoaxial stabilization, including wiring techniques, interlaminar clamp fixation, transarticular fixation, screw-plate systems, screw-rod systems, and hook-screw systems, are reviewed and discussed. Recent advancements on the novel technique of atlantoaxial fixation are described. The combination of the C1 and C2 screws in screw-rod systems are described in detail.
  
  
  RESULTS
  All fixation techniques are useful. The screw-rod system appears to be the most popular approach. However, many novel or modified fixation methods have been introduced in recent years.
  
  
  CONCLUSIONS
  Great advancements on posterior atlantoaxial fixation techniques have been made in the past decades. The wiring technique and interlaminar clamps technique have fallen out of favor because of the development of newer and superior fixation techniques. The C1-C2 transarticular screw technique may remain the gold standard for atlantoaxial fusion, whereas screw-rod systems, especially the C1 pedicle screw combined with C2 pedicle/pars screw fixation, have become the most popular fixation techniques. Hook-screw systems are alternatives for atlantoaxial fixation.
authors.affiliation: Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 76 Nanguo Rd, Xi'an, Shaanxi, 710054, China.
authors.forename: Da-Geng
authors.initials: DG
authors.lastname: Huang
authors.affiliation: Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 76 Nanguo Rd, Xi'an, Shaanxi, 710054, China. Electronic address: hdgrichard@sina.com.
authors.forename: Ding-Jun
authors.initials: DJ
authors.lastname: Hao
authors.affiliation: Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 76 Nanguo Rd, Xi'an, Shaanxi, 710054, China.
authors.forename: Bao-Rong
authors.initials: BR
authors.lastname: He
authors.affiliation: Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 76 Nanguo Rd, Xi'an, Shaanxi, 710054, China.
authors.forename: Qi-Ning
authors.initials: QN
authors.lastname: Wu
authors.affiliation: Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 76 Nanguo Rd, Xi'an, Shaanxi, 710054, China.
authors.forename: Tuan-Jiang
authors.initials: TJ
authors.lastname: Liu
authors.affiliation: Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 76 Nanguo Rd, Xi'an, Shaanxi, 710054, China.
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Wang
authors.affiliation: Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 76 Nanguo Rd, Xi'an, Shaanxi, 710054, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Guo
authors.affiliation: Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University Health Science Center, No. 76 Nanguo Rd, Xi'an, Shaanxi, 710054, China.
authors.forename: Xiang-Yi
authors.initials: XY
authors.lastname: Fang
mesh_terms: D001268:Atlanto-Axial Joint / Q000601:surgery*; D002574:Cervical Vertebrae / Q000601:surgery; D006801:Humans; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*
keywords: Atlantoaxial instability; Clamp; Lateral mass screw; Pedicle screw; Posterior fixation; Screw fixation; Wires