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

Mini-open approach combined with percutaneous transarticular screw fixation for C1-C2 fusion

Minimal invasiver Zugang kombiniert mit perkutaner transartikulärere Schraubenfixation zur C1-C2 Fusion

Meeting Abstract

  • corresponding author R. Greiner-Perth - Klinik für Wirbelsäulenchirurgie, orthopädische Chirurgie und Neurotraumatologie, SRH Waldklinikum Gera
  • Y. Allam - Klinik für Wirbelsäulenchirurgie, orthopädische Chirurgie und Neurotraumatologie, SRH Waldklinikum Gera
  • H. El Saghir - Department of orthopedics and traumatology, Al Hadra university Alexandria, Egypt

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. DocP 11.183

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

Published: May 8, 2006

© 2006 Greiner-Perth 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: This paper describes a limited exposure for posterior C1-C2 arthrodesis aided by percutaneous transarticular fixation. The purpose of this study was to report the fusion rate using the aforementioned method.

Methods: Fifty seven patients (54 females and three males) with C1-C2 instability due to rheumatoid disease constituted the material of this study. The exposure was restricted to C0-C3 levels. The drilling and insertion of the screws was done through two mini stab wounds. A special sleeve and screw driver were developed to facilitate this step. An autogenous iliac bone graft was fixed between the decorticated posterior arch of the atlas and the lamina of the axis vertebra.

Results: The mean of the atlantodental interval decreased from 8.5 mm (sd: 2.3 mm) to 2.6 mm (sd:0.6 mm) at the immediate postoperative periods and reached 2.7 mm (sd: 0.7 mm) after a mean follow-up of 30.4 months (sd: 5.6 months). Malposition of the screws was observed in two patients and warranted a second operation in one. Fusion was evident in 98% of the cases.

Conclusions: Percutaneous insertion of the screws in posterior C1-C2 transarticular fixation reduces the size of the exposure and the surgical trauma to the cervical segments below the fixation.