A Comparative Meta-Analysis of Implant-Related Complications and Fusion Rates for the Atlantoaxial Fusion with Transarticular Screws and Screw-Rod Constructs.

Abstract

Objectives. This study aims to conduct a comparative meta-analysis on the frequency of implant-related complications and fusion rates between screw-rod C1-C2 fusion (Goel-Harms technique, GHT) and transarticular atlantoaxial fusion (Magerl technique, TAF). Methods. Following PRISMA guidelines, we conducted a systematic review. An initial search in the PubMed database yielded over 5,000 abstracts. Inclusion criteria were articles in English involving both TAF and GHT, patient age over 18 years, and studies reporting on fusion incidence and/or implant-related complications, published since January 1987. Results. Sixteen studies met the inclusion criteria. The analysis revealed no significant differences in surgery duration (SMD = -0.21, 95% CI [-0.79, 0.37]) or intraoperative blood loss volume (SMD = 0.095, 95% CI [-0.41, 0.60]). Furthermore, no significant differences were observed between GHT and TAF concerning vertebral artery (VA) injury rate (OR 0.55, 95% CI [0.23 – 1.21]), screw malposition with VA canal perforation (OR 0.77, 95% CI [0.25 – 2.40]), screw malposition in other directions (OR 0.89, 95% CI [0.23-3.44]), C2 radiculopathy (OR 1.3, 95% CI [0.3 – 5.7]), implant failure (OR 0.49, 95% CI [0.16 – 1.46]), and fusion development (OR 1.97, 95% CI [0.93 – 4.16]). Begg's test indicated no publication bias. Conclusion. This meta-analysis found no significant differences between the Goel-Harms and Magerl methods regarding operation duration, intraoperative blood loss, the incidence of postoperative implant-related complications, and C1-C2 fusion rates. Further research, especially studies with a higher evidence level, is vital to develop guidelines for the most effective atlantoaxial stabilization method.