Clinical outcomes of posterior c1 and c2 screw-rod fixation for atlantoaxial instability
Makaleler > Tam Makale · 2017
Yazarlar: Hasan Serdar Isik, Evren Sandal, Sedat Cagli
Turkish Neurosurgery, Uluslararası, Wos, 2017, cilt 28, ss 602-609
DOI: 10.5137/1019-5149.jtn.20525-17.1
Özet
Although atlantoaxial instability is relatively less often reported, thanks to reasons such as the technological developments in diagnostic tools in recent years and easier access to these technological diagnostic tools, it has been more frequently seen in the practice of neurosurgery.Atlantoaxial instability may develop due to many reasons of congenital, infectious, tumor-related, degenerative or rheumatologic, and notably traumatic origin (5,13,24,34,36,44).It is reported in the literature that 3-15% of all cervical spinal traumas involve odontoid fractures and this rate can even be higher for older patients (6,12).Particularly, those of type II according to the █ INTRODUCTION C1 and C2 vertebrae are unique among all the other vertebrae in terms of their anatomical and functional differences.In addition to the fact that C1 does not have a real corpus and spinous process, lack of a disc space between C1 and C2, and that C2 has an odontoid process leads to a different and complicated ligamentous structure compared to the other vertebrae.From the functional point of view, the atlantoaxial joint is the most mobile region of the spinal column and covers 50% of cervical rotation (5).AIM: To share our experiences and to contribute to the literature by making a retrospective analysis of the patients we operated with a screw-rod system for atlantoaxial instability in our clinic. MATERIAL and METHODS:Archive files of adult patients, who were operated for posterior C1-C2 stabilization with screw and rod in our clinic between January 2006 and January 2016, were analyzed.Twenty-eight patients, who had pre-and postoperative images, follow-up forms and who were followed for at least one year, were analyzed.Preoperative clinical and radiological records, preoperative observations, postoperative complications, and clinical responses were evaluated. RESULTS:The mean age of the 28 patients (11 females and 17 males) was 44.7 years (range 21-73 years).Fixation was performed with a C1-C2 screw-rod system on the basis of the following diagnoses; type 2 odontoid fracture (n=16), basilar invagination (n=5), C1-C2 instability (n=5), and atlantoaxial subluxation secondary to rheumatoid arthritis (n=2).Lateral mass screws were inserted at the C1 segment.C2 screws were inserted on bilateral pedicle in 12 cases, bilateral pars in 4, bilateral laminar in 8 and one side pars, and one side laminar in 4 cases.There was no screw malposition.Neither implant failure nor recurrent instability was observed during the follow-up period.Significant clinical improvement was reported according to the assessments based on JOA and VAS scores.CONCLUSION: C1-C2 screw fixation is regarded as a more successful and safe method than other fixation methods in surgical treatment of atlantoaxial instability considering the complications, success in reduction, fusion and fixation strength.The C2 laminar screw technique is as successful as the other alternatives in fixation and fusion.