Three-point atlantoaxial fixation with C1-C2 transarticular screws and C1 lateral mass screws.

Abstract

Based on established posterior atlantoaxial fixation techniques, we present a novel technique that uses a polyaxial screw rod system and utilizes a combination of C1 lateral mass and C1-C2 transarticular screws. We conducted a retrospective review of six men and four women (mean age: 57, range: 20-86). Indication for atlantoaxial fixation was type II odontoid fractures or pseudarthrosis after odontoid fracture (<i>n</i> = 7), rheumatoid arthritis (<i>n</i> = 2) and os odontoideum (<i>n</i> = 1). The mean follow-up time was 48 months (range: 24-72). There were no intraoperative complications such as vertebral artery, nerve root or spinal cord injury. Post-operative imaging showed no screw malposition. During follow-up, no patient had screw loosening, screw fracture or bone absorption around the screws. Clinically, patient neck pain improved in all cases. C1 lateral mass and C1-C2 transarticular polyaxial screw rod fixation is a novel and potentially effective surgical technique for achieving immediate rigid immobilization of the C1-C2 motion segment. However, further biomechanical studies should be performed to prove our clinical results.