gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

C1-2 posterior fusion with Harms Technique (C1 lateral mass C2 pars interarticularis screwing)

Meeting Abstract

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  • corresponding author N. Asami - Department of Neurosurgery, Miyazaki University, Japan
  • S. Wakisaka - Department of Neurosurgery, Miyazaki University, Japan

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocFR.02.07

The electronic version of this article is the complete one and can be found online at:

Published: May 8, 2006

© 2006 Asami et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Transarticular screw fixation for C1-2 posterior fusion became popular among world wide neurosurgeons. It was at first described by Magerl et al in 1986 led to significant improvement in fusion rates. But careful preoperative evaluation of anatomical vertebral artery is needed and there are some complications after removal of instruments like C1-2 articulation which could deteriorate ADL. Authors introduce the Harms technique can lead to complete bone fusion without both injury of verteberal artery and facet articulation after bone fusion.

Methods: 6 patients were operated surgically and analized: C2 fracture 5 cases, (age 20-77 male 3, female 2) One granuloma C1-2 level (age 82,female), from April 2003 - October 2005 Bone fusion was analysed by CT scan and JOA score. The careful subperiosteal stripping of below surface of C1 arch was first important step. It could avoid bleeding from the venous plexus surrounding C2 root and C1-2 facet joint. The surface of C1 lateral mass is relatively hard and the risk of slipping and high speed drilling burr was used. C2 pars interarticularis screwing is very easy and safe by checking and delineating medial border of the spinal canal The anterior side of the canal could be approached with this tecnique. One clinical case was treated surgically with cutting one side C2 root.

Results: Mean operative time 3.1 hours (C2 fractures 2-3 hours, granuloma 4 hours) Blood loss 10-400 cc, No major complications. Bony fusions were completed.All patients could walk next day after surgery without cast. JOA score of all patients improved and discharged on foot.

Conclusions: C1-2 posterior fusion with Harms technique was very useful and results in strong bony fusion without navigation system. Because there caused no articulation of C1-2 joints,the patients can rotate their heads after removal of instrumentation.