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Posterior Arthrodesis in Atlantoaxial Instability: Transarticular Screw Fixation vs Wire Fixation
Jong-Ho Cho, M.D., Jung-Kil Lee, M.D., Kyung-Sub Moon M.D., Sung-Pil Joo, M.D., Jae-Hyoo Kim, M.D., and Soo-Han Kim, M.D.
Department of Neurosurgery, Chonnam National University Medical School, Gwangju, Korea
환추축성 불안정증에 대한 후방고정술 결과: 철사 고정술과 나사못 고정술Ꮿ
조종호,이정길,문경섭,주성필,김재휴,김수한
전남대학교 의과대학 신경외과학교실
Abstract
Objective: Posterior arthrodesis in atlantoaxial instability has been treated using various posterior C1-2 wiring techniques. Recently, transarticular screw fixation(TASF) technique was introduced to achieve significant immediate stability of the C1-2 joint complex. The purpose of this study is to compare the surgical results of posterior C1-2 wiring techniques with that of posterior C1-2 TASF.
Methods: We retrospectively reviewed data obtained from 38 patients who underwent C1-2 TASF or posterior wiring between 1994 and 2005 at our hospital. There were 16 women and 22 men and the mean age was 44.3 years(range from 3 to 69 years). Seventeen TASF with posterior wiring and 21 posterior wiring(18 Brooks method, 1 Gallie method, 1 Sontag interspinous method, 1 Halifax clamp) were performed. Indications for surgery included dens fracture in 11 patients, transverse ligament injury in 15, os odontoideum in 8, postodontoidectomy in 2, rheumatoid arthritis in 1 and tumor in 1 cases.
Results: In the posterior C 1-2 wiring group, 15 of 21(71%) were found to have a solid fusion, whereas there were 2(10%) apparently stable fibrous unions and 4(19%) nonunions. In the transarticular screw group, 16 of 17 developed a solid fusion and one developed an apparently stable fibrous union. In the posterior C 1-2 wiring group, the pain was resolved completely in 16 of 21(76%) patients, improved in 2 patients, no change in a patient and aggravated in 2 patients. However, the pain was improved markedly(3 patients) or resolved completely(14 patients)in the TASF group. There was no case of neurological deterioration, hypoglossal nerve injury, or vertebral artery injury.
Conclusion: The C1-C2 transarticular screw fixation with supplemental C1-2 wiring have provided a significantly higher fusion rate than the C1-C2 posterior wiring procedures using autograft. Preoperative evaluation and planning is mandatory for optimal safety. With the knowledge of local anatomy and meticulous surgical technique, C 1-2 posterior transarticular screw fixation supplemented by posterior wiring is a safe and effective procedure of achieving atlantoaxial fusion.
Keywords: Posterior wiring․Transarticular screw fixation


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