J Korean Neurosurg Soc.  2012 Aug;52(2):120-125. 10.3340/jkns.2012.52.2.120.

Posterior Atalntoaxial Fusion with C1 Lateral Mass Screw and C2 Pedicle Screw Supplemented with Miniplate Fixation for Interlaminar Fusion : A Preliminary Report

  • 1Department of Neurosurgery, College of Medicine, Catholic University of Daegu, Daegu, Korea. daehkim@cu.ac.kr


To investigate the feasibility of C1 lateral mass screw and C2 pedicle screw with polyaxial screw and rod system supplemented with miniplate for interlaminar fusion to treat various atlantoaxial instabilities.
After posterior atlantoaxial fixation with lateral mass screw in the atlas and pedicle screw in the axis, we used 2 miniplates to fixate interlaminar iliac bone graft instead of sublaminar wiring. We performed this procedure in thirteen patients who had atlantoaxial instabilities and retrospectively evaluated the bone fusion rate and complications.
By using this method, we have achieved excellent bone fusion comparing with the result of other methods without any complications related to this procedure.
C1 lateral mass screw and C2 pedicle screw with polyaxial screw and rod system supplemented with miniplate for interlaminar fusion may be an efficient alternative method to treat various atlantoaxial instabilities.


Atalantoaxial stabilization; Cervical spine; Interlaminar fusion

MeSH Terms

Axis, Cervical Vertebra
Retrospective Studies


  • Fig. 1 A : Preoperative plan for paramedian approach. 3-4 cm length incision was made 1.5-2 cm off to midline bilaterally. B : Tubular retractor and Quadrant of METRX system (Medtronics®) was used to dissect paravertebral musculature.

  • Fig. 2 A : Intraoperative picture of the procedure with paramedian approach. B : Intraoperative picture of the procedure with classical midline approach.

  • Fig. 3 Preoperative dynamic X-ray of case 1. Black arrow shows widen ADI when patient is flexed.

  • Fig. 4 Postoperative X-ray of case 1. Stapler mark shows the extent of paramedian incision.

  • Fig. 5 4.5 months after the operation of case 1. Notice solid bone fusion occurred between C1-C2 lamina.

  • Fig. 6 Preoperative MRI of case 2. White arrow shows type II odontoid process fracture. Bold white arrow shows transverse ligament injury.

  • Fig. 7 Postoperative X-ray of case 2. Stapler mark shows the extent of classical midline incision.


1. Anderson LD. The Cervical Spine Research Society. Fractures of the odontoid process of the axis. The Cervical Spine. 1983. Philadelphia: JB Lippincott;p. 206–223.
2. Apuzzo ML, Heiden JS, Weiss MH, Ackerson TT, Harvey JP, Kurze T. Acute fractures of the odontoid process. An analysis of 45 cases. J Neurosurg. 1978; 48:85–91. PMID: 619027.
3. Brooks AL, Jenkins EB. Atlanto-axial arthrodesis by the wedge compression method. J Bone Joint Surg Am. 1978; 60:279–284. PMID: 348703.
4. Clark CR, Goetz DD, Menezes AH. Arthrodesis of the cervical spine in rheumatoid arthritis. J Bone Joint Surg Am. 1989; 71:381–392. PMID: 2925711.
5. Dickman CA, Sonntag VK. Posterior C1-C2 transarticular screw fixation for atlantoaxial arthrodesis. Neurosurgery. 1998; 43:275–280. discussion 280-281. PMID: 9696080.
6. Dickman CA, Sonntag VK, Papadopoulos SM, Hadley MN. The interspinous method of posterior atlantoaxial arthrodesis. J Neurosurg. 1991; 74:190–198. PMID: 1988587.
7. Fielding JW. Current concepts review. The status of arthrodesis of the cervical spine. J Bone Joint Surg Am. 1988; 70:1571–1574. PMID: 3058713.
8. Fountas KN, Kapsalaki EZ, Karampelas I, Dimopoulos VG, Feltes CH, Kassam MA, et al. C1-C2 transarticular screw fixation for atlantoaxial instability. South Med J. 2004; 97:1042–1048. PMID: 15586592.
9. Gallie WE. Fracture and dislocations of the cervical spine. Am J Surg. 1939; 46:495–499.
10. Gluf WM, Schmidt MH, Apfelbaum RI. Atlantoaxial transarticular screw fixation : a review of surgical indications, fusion rate, complications, and lessons learned in 191 adult patients. J Neurosurg Spine. 2005; 2:155–163. PMID: 15739527.
11. Goel A, Desai KI, Muzumdar DP. Atlantoaxial fixation using plate and screw method: a report of 160 treated patients. Neurosurgery. 2002; 51:1351–1356. discussion 1356-1357. PMID: 12445339.
12. Griswold DM, Albright JA, Schiffman E, Johnson R, Southwick W. Atlanto-axial fusion for instability. J Bone Joint Surg Am. 1978; 60:285–292. PMID: 348704.
13. Grob D, Crisco JJ 3rd, Panjabi MM, Wang P, Dvorak J. Biomechanical evaluation of four different posterior atlantoaxial fixation techniques. Spine (Phila Pa 1976). 1992; 17:480–490. PMID: 1621145.
14. Grob D, Jeanneret B, Aebi M, Markwalder TM. Atlanto-axial fusion with transarticular screw fixation. J Bone Joint Surg Br. 1991; 73:972–976. PMID: 1955447.
15. Haid RW Jr, Subach BR, McLaughlin MR, Rodts GE Jr, Wahlig JB Jr. C1-C2 transarticular screw fixation for atlantoaxial instability : a 6-year experience. Neurosurgery. 2001; 49:65–68. discussion 69-70. PMID: 11440461.
16. Hanson PB, Montesano PX, Sharkey NA, Rauschning W. Anatomic and biomechanical assessment of transarticular screw fixation for atlantoaxial instability. Spine (Phila Pa 1976). 1991; 16:1141–1145. PMID: 1754933.
17. Harms J, Melcher RP. Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976). 2001; 26:2467–2471. PMID: 11707712.
18. Horn EM, Hott JS, Porter RW, Theodore N, Papadopoulos SM, Sonntag VK. Atlantoaxial stabilization with the use of C1-3 lateral mass screw fixation. Technical note. J Neurosurg Spine. 2006; 5:172–177. PMID: 16925087.
19. Jeanneret B, Magerl F. Primary posterior fusion C1/2 in odontoid fractures : indications, technique, and results of transarticular screw fixation. J Spinal Disord. 1992; 5:464–475. PMID: 1490045.
20. Jun BY. Anatomic study for ideal and safe posterior C1-C2 transarticular screw fixation. Spine (Phila Pa 1976). 1998; 23:1703–1707. PMID: 9704379.
21. Kim SM, Lim TJ, Paterno J, Hwang TJ, Lee KW, Balabhadra RS, et al. Biomechanical comparison of anterior and posterior stabilization methods in atlantoaxial instability. J Neurosurg. 2004; 100:277–283. PMID: 15029916.
22. Kuroki H, Rengachary SS, Goel VK, Holekamp SA, Pitkänen V, Ebraheim NA, et al. Biomechanical comparison of two stabilization techniques of the atlantoaxial joints : transarticular screw fixation versus screw and rod fixation. Neurosurgery. 2005; 56:151–159. discussion 151-159. PMID: 15799804.
23. Magerl FSP. Kehr P, Weidner A, editors. Stable posterior fusion of the atlas and axis by transarticular screw fixation. Cervical Spine I. 1987. New York: Springer Wien Berlin Heidelberg;p. 322–327.
24. Mandel IM, Kambach BJ, Petersilge CA, Johnstone B, Yoo JU. Morphologic considerations of C2 isthmus dimensions for the placement of transarticular screws. Spine (Phila Pa 1976). 2000; 25:1542–1547. PMID: 10851104.
25. Marcotte P, Dickman CA, Sonntag VK, Karahalios DG, Drabier J. Posterior atlantoaxial facet screw fixation. J Neurosurg. 1993; 79:234–237. PMID: 8331406.
26. McGraw RW, Rusch RM. Atlanto-axial arthrodesis. J Bone Joint Surg Br. 1973; 55:482–489. PMID: 4729017.
27. Montesano PX, Juach EC, Anderson PA, Benson DR, Hanson PB. Biomechanics of cervical spine internal fixation. Spine (Phila Pa 1976). 1991; 16:S10–S16. PMID: 2028323.
28. Naderi S, Crawford NR, Song GS, Sonntag VK, Dickman CA. Biomechanical comparison of C1-C2 posterior fixations. Cable, graft, and screw combinations. Spine (Phila Pa 1976). 1998; 23:1946–1955. discussion 1955-1956. PMID: 9779526.
29. Paradis GR, Janes JM. Posttraumatic atlantoaxial instability : the fate of the odontoid process fracture in 46 cases. J Trauma. 1973; 13:359–367. PMID: 4573254.
30. Paramore CG, Dickman CA, Sonntag VK. The anatomical suitability of the C1-2 complex for transarticular screw fixation. J Neurosurg. 1996; 85:221–224. PMID: 8755749.
31. Sonntag VK, Kalfas I. Innovative cervical fusion and instrumentation techniques. Clin Neurosurg. 1991; 37:636–660. PMID: 2009712.
32. Wang MY, Levi AD. Minimally invasive lateral mass screw fixation in the cervical spine : initial clinical experience with long-term follow-up. Neurosurgery. 2006; 58:907–912. discussion 907-912. PMID: 16639325.
33. White AA 3rd, Panjabi MM. The clinical biomechanics of the occipitoatlantoaxial complex. Orthop Clin North Am. 1978; 9:867–878. PMID: 740380.
34. Wright NM, Lauryssen C. Vertebral artery injury in C1-2 transarticular screw fixation : results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves. American Association of Neurological Surgeons/Congress of Neurological Surgeons. J Neurosurg. 1998; 88:634–640. PMID: 9525707.
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