Stand-Alone C1-C2 Goel-Harms Instrumentation in Atlantoaxial Instability without Grafting: A Clinicoradiological Follow-Up Study.

Abstract

This study aims to evaluate clinical and radiological outcomes of patients with atlantoaxial instability treated with stand-alone atlas (C1)-axis (C2) lateral mass/pedicle/pars screw-rod instrumentation without supplemental grafting materials. Between July 2014 and January 2022, data from 64 adults undergoing stand-alone, navigated posterior C1-C2 screw-rod fixation were retrospectively collected. Radiological outcome assessment involved cervical computer tomography scans and X-ray radiographs evaluating osseous intervertebral fusion and implant failure. Clinical outcome assessment included patient-reported outcome measures encompassing pain levels using the numeric pain rating scale, patient satisfaction according to Odom criteria, and pain-related disability in activities of daily life by the neck disability index (NDI). Radiological outcome evaluation revealed progressive osseous fusion over time with 100% fusion achieved at follow-up (mean: 12.3 ± 15.4 months) and low overall rates of implant failure (3.1%). Clinical outcome evaluation demonstrated mild pain levels (median numeric pain rating scale: 2), good patient satisfaction (median Odom criteria: 2), and moderate neck disability (median NDI/NDI%: 11/22.2%), which remained stable over a mean follow-up time of 29 ± 16.6 months. Stand-alone C1-C2 lateral mass/pedicle/pars screw-rod instrumentation without grafting is a viable option for treatment of atlantoaxial instability. This technique offers favorable clinical and radiological outcomes while avoiding complications associated with grafting.