Atlantoaxial Stabilization by Posterior C1 and C2 Screw-Rod Fixation for Various Pathologies: Case Series and Comprehensive Review of Literature

Abstract

We retrospectively analyzed atlantoaxial dislocation (AAD) of various pathologies, namely, rheumatoid arthritis (RA), os odontoideum, and trauma. Various techniques were discussed in relation to C1-C2 stabilization. The study aims to share our clinical experience in a series of six cases of C1-C2 instability that underwent posterior C1-C2 fusion, with free hand technique and limited fluoroscopy. The clinicoradiological presentation for each patient is described. We reviewed different literatures related to our case vividly and focused on the basic neuroanatomy involved in the atlantoaxial joint. All patients of AAD had evidence of severe canal compromise and chronic compressive spinal cord changes. In our study, the patients age ranged from 28 to 52 years. The study included four males and two females. Out of six patients of AAD, three had history of trauma, two had os odontoideum, and one had chronic inflammatory condition (RA). From our case series, we concluded that the Goel–Harms technique is the most versatile and surgeon friendly technique for C1-C2 fixation. Early recognition and surgical intervention of atlantoaxial joint instability is essential to prevent catastrophic neurological complications.

C1-C2 Rotatory Subluxation in Adults “A Narrative Review”

“…Arthrodesis of the C1-C2 vertebrae is one of the techniques of choice when non-surgical treatment fails. The osteosynthesis devices must create multidirectional stabilization by short segmental fixation, leaving as many mobile segments free as possible [ 51 , 52 , 53 , 54 , 55 , 56 ]. In short, cervical spine fixation makes it possible to restore stability or correct the alignment of the vertebrae.…”

The retropharyngeal reduction plate for atlantoaxial dislocation: a finite element analysis

“…Among them, surgery is the most important means of treating AAD. At present, according to the different types of AAD, the surgical treatment methods mainly include anterior release and fixation, posterior reduction fixation, and combined anterior release and posterior fixation ( Govindasamy et al, 2020 ; Unni et al, 2021 ). For most patients, posterior fixation fusion, with the assistance of skull traction, can achieve good clinical efficacy in one stage ( Guo et al, 2020 ).…”