J Korean Neurosurg Soc.  2014 May;55(5):255-260. 10.3340/jkns.2014.55.5.255.

Comparison of Outcomes after Atlantoaxial Fusion with Transarticular Screws and Screw-Rod Constructs

• Kim JY
• Oh CH
• Yoon SH
• Park HC
• Seo HS

• KMID: 2018030
• DOI: http://doi.org/10.3340/jkns.2014.55.5.255

Abstract

OBJECTIVE
The purpose of this study was to compare the radiological and neurological outcomes between two atlantoaxial fusion method for atlantoaxial stabilization; C1 lateral mass-C2 pedicle screws (screw-rod constructs, SRC) versus C1-2 transarticular screws (TAS).
METHODS
Forty-one patients in whom atlantoaxial instability was treated with atlantoaxial fixation by SRC group (27 patients, from March 2005 to May 2011) or TAS group (14 patients, from May 2000 to December 2005) were retrospectively reviewed. Numeric rating scale (NRS) for pain assessment, Oswestry disability index (ODI), and Frankel grade were also checked for neurological outcome. In radiologic outcome assessment, proper screw position and fusion rate were checked. Perioperative parameters such as blood loss during operation, operation time, and radiation exposure time were also reviewed.
RESULTS
The improvement of NRS and ODI were not different between both groups significantly. Good to excellent response in Frankel grade is shown similarly in both groups. Proper screw position and fusion rate were also observed similarly between two groups. Total bleeding amount during operation is lesser in SRC group than TAS group, but not significantly (p=0.06). Operation time and X-ray exposure time were shorter in SRC group than in TAS group (all p<0.001).
CONCLUSION
Both TAS and SRC could be selected as safe and effective treatment options for C1-2 instability. But the perioperative result, which is technical demanding and X-ray exposure might be expected better in SRC group compared to TAS group.

Keyword

Atlantoaxial fixation; C-1 lateral mass screw; C-2 pedicle screw; Transarticular screw; Complications; Fusion

MeSH Terms

Hemorrhage
Humans
Pain Measurement
Retrospective Studies

Figure

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  Fig. 1 Lateral plain radiographs of a 65-year-old female showing. A : The severely dislocated atlas and axis caused by complication of rheumatoid arthritis. B : Reduction and screw positioning of the C1-2 complex postoperatively.

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  Fig. 2 A 66-year-old female had C1-2 instability due to complication of rheumatoid arthritis. Postoperative X-ray and CT scans show that the screw was safely inserted through the C1 lateral mass and the C2 pedicle. A : Pre-operative MRI. B : Post-operative cervical X-ray. C and D : Postoperative CT scans.

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  Fig. 3 Comparison of clinical results (operation time, radiation exposure time, blood loss) between transarticular screw fixation and C1 lateral mass-C2 pedicle screw fixation (*p<0.05).

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