gms | German Medical Science

54. Jahrestagung der Norddeutschen Orthopädenvereinigung e. V.

Norddeutsche Orthopädenvereinigung

16.06. bis 18.06.2005, Hamburg

The dorsal transarticular spondylodesis C1/C2 (Magerl's procedure): a retrospective study of patients with atlanto-axial instability and rheumatoid arthritis

Meeting Abstract

Search Medline for

  • corresponding author J. Neumann - ENDO-Klinik, Orthopädie, Hamburg
  • J. Löhr - Hamburg
  • D. Grob - Zürich

Norddeutsche Orthopädenvereinigung. 54. Jahrestagung der Norddeutschen Orthopädenvereinigung e.V.. Hamburg, 16.-18.06.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc05novW4.03

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

Published: June 13, 2005

© 2005 Neumann 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.




About 20% of patients with rheumatoid arthritis develop an atlanto-axial instability. A once established instability tends to proceed and sometimes may lead to a lifethreatenning condition. Until now the only therapy is surgical atlanto-axial stabilization. In a retrospective study the results of the dorsal transarticular spondylodesis at C1/C2 level are presented (Magerl´s procedure).

Patients and Method

At the Schulthess-Klinik in Zuerich 98 patients (75 female and 23 male) were treated between 1987 and 2000 for an atlanto-axial instability with the above mentioned procedure. The average age was 58.7 years. The mean postoperative follow-up was 7.1 years (maximum 14 years, minimum 3 months), consisting of a physical medical examination, x-rays and a questionary.


The operation led to a significant decrease of neck-pain on the visualizid pain scale rating from zero to ten. Only 4% of the patients were unsatisfied with the operation´s result and only 6% would not undergo this procedure anew. Radiologically 93% of the patients showed a solid integration of the cortico-spongious bone. In ten cases a fracture of one or both screws was noticed, but only three patients showed a clinically significant instability resulting in a respondylodesis.


The transarticular dorsal spondylodesis at C1/2 is a reliable method of neck-pain reduction and removal of the atlanto-axial instability for patients with rheumatoid arthritis. Taking into consideration the poor bone quality of polyarthritic patients, the fusion rate of the Magerl procedure is very satisfying.