Article
Open versus percutaneous atlantoaxial stabilization
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Authors
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R. Schmidt
- Orthopädische Klinik mit Querschnittgelähmtenzentrum, der Universität Ulm, Ulm
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W. Puhl
- Ulm
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B. Cakir
- Ulm
| Published: | June 13, 2005 |
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Outline
Text
Introduction
A frequently used method for atlantoaxial stabilization is posterior bilateral transarticular screws in addition with a posterior one point fixation. Nevertheless the posterior approach is quite large to achieve sufficient screw angulation. Therefore McGuire and Harkey invented in 1995 a percutaneous approach with smaller incision. This technique should theoretically account for a shorter operation time, smaller blood loss and still achieve a equal or better screw angulation.
Material and Methods
Two groups, each consisting of 17 patients, which all had a posterior three point fixation for atlantoaxial instability were compared. The intraoperative and postoperative blood loss, as well as the operation time was acquired. In the postoperative x-rays, the screw angulation was measured to detect possible differences, concerning the feasibility of screw placement. Statistical analysis was done with the Mann-Whitney Test.
Results
The operation time was significantly shorter in the percutaneous group, with a mean of 110.6 minutes, compared to 175.3 minutes in the open group. The intra-, as well as the postoperative blood loss showed significant differences. The screw angulation showed a slighty steeper angulation in the percutaneous group with 56.8°, compared to 53.9° in the open group, but this was not statistically significant.
Conclusions
The percutaneous technique showed intraoperative benefits compared to the open technique, which could lead to a lower morbidity of the procedure. Despite the smaller incision, an at least equal or slightly better screw angulation can be achieved. This is probably an effect of the trocar system used for the percutaneous approach.
