gms | German Medical Science

54. Jahrestagung der Norddeutschen Orthopädenvereinigung e. V.

Norddeutsche Orthopädenvereinigung

16.06. bis 18.06.2005, Hamburg

Open versus percutaneous atlantoaxial stabilization

Meeting Abstract

Search Medline for

  • corresponding author R. Schmidt - Orthopädische Klinik mit Querschnittgelähmtenzentrum, der Universität Ulm, Ulm
  • W. Puhl - Ulm
  • B. Cakir - Ulm

Norddeutsche Orthopädenvereinigung. 54. Jahrestagung der Norddeutschen Orthopädenvereinigung e.V.. Hamburg, 16.-18.06.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc05novW1.12

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

Published: June 13, 2005

© 2005 Schmidt 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.




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.


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.


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.