gms | German Medical Science

Posterior C1-2 fixation was first described by Goel in 1994 and slightly modified by Harms, who also published his results in 2001. Since then, this type of posterior fixation gained international acceptance. Moreover, the method is anticipated to have advantages with respect to anterior screw fixation and to posterior C1-2 fixation acc. to Magerl (more safe, esp. with respect to vertebral artery injury). However, there is a paucity of clinical information concerning these.

Aim: is to analyse the rate and type of early postop complications following C1-2 fixation according to Goel–Harms. A special attention was set on patients, admitted to our institution with failed anterior odontoid screw fixation

Methods: Data for this study were taken from our hospital database, checked for this study via OPS10 code “S12.1 – fracture of the 2nd vertebra” between March 2011 to July 2018. Next, only patients having received a C1-2 fixation according to Goel-Harms were selected. Data concerning age, sex, complications were extracted from all clinical data sheets. Complications were classified into 3 groups: Surgery related major complications, surgery related minor complications, others (related to heart, lung, kidney, etc), documented within the early postop follow up, which was 3 months after surgery. Moreover, mean blood loss was calculated, and we looked at human blood products given after surgery including autologous blood transfusion.

Results: 135 patients, mean age 75 years, 53% female. Surgery related major complications: Vertebralartery injury: 0%, thecalsac injury 0%, transvers lesion 0%, early implant failure 4%. Surgery related minor complications: Neck pain combined with C2 dysesthesia 5%, superficial wound infection 3%. Others: for more information please check Table 1 [Tab. 1]. Mortality 2%. Mean blood loss was 374ml, 12 patients received human blood products, 6 patients received autologous blood transfusion. In 8 patients, admitted with failed anterior odontoid screw fixation, the procedure was used for revision with uneventfull course in all.

Conclusion: Checking the type and rate of complications in patients suffering from C2 fractures, posterior fixation acc. to Goel-Harms is safe and effective. Within 8 years, we didn’t see a single lesion to the vertebral artery or of the thecalsac, mortality in this population with a mean age of 75 years was 2%. Thus, the procedure is a usefull add-on to the classic procedures, being anterior odontoid screw fixation or C1-2 fixation acc. to Magerl.