Atlantoaxial transarticular screw fixation and posterior fusion using polyester cable: a 10-year experience

Abstract

Purpose To retrospective review the clinical outcomes of the modified operative technique using a polyester suture material (Ethibond* Excel) for atlantoaxial transarticular screw fixation and posterior fusion. Methods The retrospective reviews were conducted from 2002 to 2012. The patient's medical record reviews included demographic data, cause of atlantoaxial instability, orthopedic and surgical history, clinical presentation, radiographic finding including plain radiography, complications, operative detail, and outcome of treatment. Fusion of C1-C2 was defined as either graft consolidation or absence of C1-C2 movement on lateral flexion-extension radiograph.Results Twenty-three patients demonstrated clinical and radiographic evidence of atlantoaxial instability (13 men and 10 women, with a mean age of 42 years). Majority of atlantoaxial instability was caused by trauma. Most common clinical symptom was neck pain with or without cervical myelopathy. Bilateral screws were placed in 18 of the 23 patients. Five patients underwent placement of unilateral screws. The 13 patients were inserted by screws with diameter 4.0 mm. The means screw length was 40.33 mm. The means of operative time and estimated blood loss were 3.6 h and 234 ml, respectively. The mean of follow-up duration was 18 months. All 41 screws were positioned satisfactorily in C1 lateral mass. All 23 patients achieved fusion (100 % fusion rate). After a period of follow-up, 9 of the 10 neurological deficit patients had completely recovered. Conclusions We concluded that the atlantoaxial transarticular screw fixation and posterior fusion using polyester cable can be used for C1-2 fusion with a high fusion rate and less complications in various cases.

Outcome Instruments in Spinal Trauma Surgery: A Bibliometric Analysis

“…3). 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63…”

Muscle fascia graft as a potential treatment for cervical dura defects: A case report of a C2-C3 dumbbell schwannoma

“…Literature regarding the use of this suture in spine surgery is scarce. Sutipornpalangkul and Thanapipatsiri (2013) reported few complications with the use of this material in C1-C2 fixation and fusion, even in patients with rheumatoid arthritis 15 . In our experience, we have not presented any complications with the use of this type of suture in the past.…”

A prospective, double-blind, randomized controlled trial of treatment of atlantoaxial instability with C1 posterior arches >4 mm by comparing C1 pedicle with lateral mass screws fixation

“…The dens and ligamentous structures are critical to maintain the stability of atlantoaxial joints. Various pathological conditions that lead to abnormalities of these structures will result in AAI, which an atlantoaxial fixation will be required to repair vertebral deformity, restore their stability and avoid neurological consequences [ 2 , 4 ]. Many surgical approaches have been developed and applied clinically to treat AAI, including posterior interspinous fusion with sublaminar wires, iliac bone grafts, interlaminar clamps, C1-C2 transarticular screw fixation and posterior atlantoaxial fixation with polyaxial screws and rods.…”

“…Another example is transarticular screw technique, which provides good stability in rotatory motion and has no requirement of posterior vertebral elements intact, with drawbacks of anatomical variations such as irreducible C1-C2 subluxation. The recent posterior transpedicular screw fixation techniques render favorable biomechanical properties and wide indications, which have been gaining increasingly attention by spine surgeons [ 2 – 4 , 6 – 8 ].…”