gms | German Medical Science

Objective: Several techniques for treating atlantoaxial instability have been described. The most accepted treatment modalities are the Magerl transarticular screw fixation and the Harms/Goel C1–C2 rod technique. Based on these established posterior atlantoaxial fixation techniques, we present a novel technique that uses a polyaxial screw rod system and utilizes a combination of C1 lateral mass and C1-C2 transarticular screws.

Methods: Retrospective review of seven men and five women (mean age: 63, range: 20-86). Indication for surgery was type II odontoid fractures (n = 6), pseudarthrosis after anterior odontoid screw placement (n = 3), atlantoaxial instability after C3-C5 fusion (n = 1), Os odontoideum (n=1) and craniovertebral rheumatoid arthritis (n = 1).

Results: The mean follow-up time was 22 months (range: 3-72). There were no intraoperative complications. Postoperative imaging showed no screw malposition. During follow-up no patient had screw loosening, screw fracture, or bone absorption around the screws. Clinically, patient neck pain improved in all cases.

Conclusion: C1 lateral mass and C1-C2 transarticular polyaxial screw rod fixation is a novel and potentially effective surgical technique for achieving immediate rigid immobilization of the C1-C2 motion segment.

Figure 1 [Fig. 1]