title: Comparison of Transarticular Screw Fixation and C1 Lateral Mass-C2 Pedicle Screw Fixation in Patients with Rheumatoid Arthritis with Atlantoaxial Instability.
abstract: BACKGROUND
  Many surgical procedures have been introduced to manage atlantoaxial instability caused by rheumatoid arthritis (RA) to prevent complications and improve fusion rate. We report the surgical outcome between transarticular screw fixation (TAF) and C1 lateral mass-C2 pedicle screw fixation (C1LM-C2P) in patients with atlantoaxial instability from RA.
  
  
  METHODS
  Between 2002 and 2012, 58 patients were enrolled in the study. According to surgical procedures, patients were divided into 2 groups: group I who received TAF (n = 33) and group II who received C1LM-C2P (n = 25). Bony fusion was assessed by radiologic comparison immediately after the operation and 1 year postoperatively. In addition, complications and clinical and functional outcomes were evaluated.
  
  
  RESULTS
  Overall, bone fusion was achieved in 32 patients in group I (97%). In group II, the fusion rate was evaluated in 100% of patients. Complications (regardless of neurologic deterioration) were cable loosening and screw malposition in group I and violation into the vertebral canal and spinal canal in group II. There was no statistical significance in fusion rate, clinical outcomes, or complications. The 12-month atlantodental interval after operation for the C1LM-C2P group was significantly lower than that for the TAF group after adjusting for all variables.
  
  
  CONCLUSIONS
  Two surgical techniques showed a good fusion rate by rigid fixation in the immediate postoperative period and fewer surgery-related complications in patients with RA. Because surgical complications are more likely during the learning curve (as with other surgical techniques), surgeons should carefully evaluate patients before surgery by radiologic and neurologic examinations.
authors.affiliation: Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea.
authors.forename: Je Il
authors.initials: JI
authors.lastname: Ryu
authors.affiliation: Department of Neurosurgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Sungdong-gu, Seoul, Republic of Korea.
authors.forename: Koang Hum
authors.initials: KH
authors.lastname: Bak
authors.affiliation: Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea.
authors.forename: Jae Min
authors.initials: JM
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Sungdong-gu, Seoul, Republic of Korea. Electronic address: tdy815@hanyang.ac.kr.
authors.forename: Hyoung-Joon
authors.initials: HJ
authors.lastname: Chun
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000453:epidemiology / Q000601:surgery*; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D015984:Causality; D003131:Combined Modality Therapy / Q000295:instrumentation / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D065289:Pedicle Screws / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D015995:Prevalence; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000295:instrumentation* / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Atlantoaxial instability; Bone fusion; C1 lateral mass-C2 pedicle screw fixation; Complication; Rheumatoid arthritis; Transarticular screw fixation