Atlantoaxial Fixation Using Plate and Screw Method: A Report of 160 Treated Patients

Abstract

The plate and screw method of fixation with the use of intra-articular bone grafts in patients with atlantoaxial instability yielded a 100% fusion rate with a low incidence of complications.

Clinical and radiological Comparison of treatment of atlantoaxial instability by posterior C1–C2 transarticular screw fixation or C1 lateral mass-C2 pedicle screw fixation

“…Both Harms and Melcher and Goel et al succeeded in achieving the C1-C2 bony fusion in 100% of patients. 8,14 This study also had a 100% fusion rate except for one instance of early rod loosening in group 2.…”

“…8,11,14 The main advantages of this technique were: (i) minimal risk of VA and spinal cord injury; (ii) integrity of the C1 or C2 posterior elements was not necessary for stable fixation; and (iii) this technique allowed a reduction in any displacement of the elements of the atlantoaxial complex by repositioning the patient's head or directly manipulating the C1 or C2 screws. 8,[11][12][13][14]20 Compared with a posterior wiring procedure, the screw-rod system does not require intact posterior elements, which can be disrupted under conditions such as trauma. Similarly, although the laminar screw system does not protrude into the spinal canal, it requires intact posterior elements.…”

“…Goel and Laheri and Goel et al reported that patients tolerated the dissection of the nerve quite well. 11,14 However, a different experience was described in the commentary at the end of the report. Harms and Melcher insist that the risk of injury or irritation of the C2 nerve root can be avoided by traction of the root inferiorly during screw insertion.…”

“…8 Although there have been many clinical analyses of each technique, these two approaches have not been compared in the management of atlantoaxial instability except for several biomechanical studies. [11][12][13][14][15][16][17][18][19][20] The aim of this study was to compare the clinical and radiographic results and complications in patients who underwent a C1 lateral mass-C2 pedicle screw fixation for atlantoaxial instability to a matched group of patients treated using C1-C2 transarticular screw fixation at the same institution.…”

Vertical atlantoaxial dislocation as a cause of failure of midline fixation

“…A bone graft was placed in the distracted joint and plate and screw fixation (screws implanted directly into the lateral masses of atlas and axis) was performed. [2][3][4][5] Additional bone graft pieces were placed in the midline over the previously operated area.…”