gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Autograft vs. alloplastic fusion material in posterior C1-2 fusion with C1 lateral mass and C2 isthmic screws

Meeting Abstract

  • A. Reinke - Neurochirurgische Klinik des Klinikums rechts der Isar der Technischen Universität München
  • M. Behr - Neurochirurgische Klinik des Klinikums rechts der Isar der Technischen Universität München
  • A. Preuss - Neurochirurgische Klinik des Klinikums rechts der Isar der Technischen Universität München
  • F. Ringel - Neurochirurgische Klinik des Klinikums rechts der Isar der Technischen Universität München
  • B. Meyer - Neurochirurgische Klinik des Klinikums rechts der Isar der Technischen Universität München
  • M. Stoffel - Klinik für Neurochirurgie, Helios Klinikum Krefeld GmbH

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocDO.12.07

DOI: 10.3205/12dgnc112, URN: urn:nbn:de:0183-12dgnc1126

Published: June 4, 2012

© 2012 Reinke et al.
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Outline

Text

Objective: For atlantoaxial fusion, the dorsal C1/2 stabilisation in Harms technique is often used. For achieving a sufficient fusion it is already well known that the use of grafts is inalienable. Literature shows a fusion rate of nearly 100% for bone grafting with an iliac crest autograft in big series. Alloplastic fusion material appears as a potential alternative. Accordingly, we describe our preliminary experience with both fusion materials in a retrospective fashion

Methods: 27 patients treated at our institution since May 2006 were included. Screw position and reduction/realignment were assessed by postoperative thin-cut CT scans. For follow-up, radiographic data and the clinical status were collected. Material failure was excluded by radiographic parameters like screw loosening, dislocation or fracture and by the clinical status:

Results: A total of 27 (10 females and 17 males) patients requiring atlantoaxial fusion for instabilities were included. Mean age was 60.0 years (range 4–91 years). 19 patients were operated for traumatic, one for neoplastic, three for infectious, two for degenerative, and two for congenital instabilities. No neurological or vascular injuries occurred. 12 patients were treated with a bicortical iliac crest allograft and 15 with an alloplastic implant. After a mean follow-up period of 18 months (range 1–41) our follow-up rate was 78% (21 patients). Ten patients treated with autologous bone were available for the follow-up examination (83%). From these ten patients, nine had already a radiographic and clinical fusion (90%). Only one Patient had a reappeared neck pain as a sign for non-fusion. In the group of patients treated with an alloplastic implant, we had a fusion rate of 91%. One patient of this group had radiographic (screw loosening) and clinical signs of non-fusion. 11 of all 15 patients with an alloplastic implant could complete their follow-up (73%).

Conclusions: In our experience, alloplastic materials supplementing the Harms technique for atlantoaxial fusion are a comparable alternative to the gold standard with the bicortical iliac crest autograft. Nevertheless there are some strict indications for the autograft, for example infection. But for confirming our experience a multicenter study with a long-term follow-up would be desirable.