J Korean Neurosurg Soc.  2015 Jun;57(6):460-464. 10.3340/jkns.2015.57.6.460.

Unilateral C1 Lateral Mass and C2 Pedicle Screw Fixation for Atlantoaxial Instability in Rheumatoid Arthritis Patients: Comparison with the Bilateral Method

• Paik SC
• Chun HJ
• Bak KH
• Ryu J
• Choi KS

• KMID: 2191255
• DOI: http://doi.org/10.3340/jkns.2015.57.6.460

Abstract

OBJECTIVE
Bilateral C1 lateral mass and C2 pedicle screw fixation (C1LM-C2P) is an ideal technique for correcting atlantoaxial instability (AAI). However, the inevitable situation of vertebral artery injury or unfavorable bone structure may necessitate the use of unilateral C1LM-C2P. This study compares the fusion rates of the C1 lateral mass and C2 pedicle screw in the unilateral and bilateral methods.
METHODS
Over five years, C1LM-C2P was performed in 25 patients with AAI in our institute. Preoperative studies including cervical X-ray, three-dimensional computed tomography (CT), CT angiogram, and magnetic resonance imaging were performed. To evaluate bony fusion, measurements of the atlanto-dental interval (ADI) and CT scans were performed in the preoperative period, immediate postoperative period, and postoperatively at 1, 3, 6, and 12 months.
RESULTS
Unilateral C1LM-C2P was performed in 11 patients (44%). The need to perform unilateral C1LM-C2P was due to anomalous course of the vertebral artery in eight patients (73%) and severe degenerative arthritis in three patients (27%). The mean ADI in the bilateral group was 2.09 mm in the immediate postoperative period and 1.75 mm in 12-months postoperatively. The mean ADI in the unilateral group was 1.82 mm in the immediate postoperative period and 1.91 mm in 12-months postoperatively. Comparison of ADI measurements showed no significant differences in either group (p=0.893), and the fusion rate was 100% in both groups.
CONCLUSION
Although bilateral C1LM-C2P is effective for AAI from a biomechanical perspective, unilateral screw fixation is a useful alternative in patients with anatomical variations.

Keyword

Atlantoaxial; Bilateral; C1-2; Harm's Technique; Instability; Unilateral

MeSH Terms

Arthritis, Rheumatoid*
Humans
Magnetic Resonance Imaging
Osteoarthritis
Postoperative Period
Preoperative Period
Tomography, X-Ray Computed
Vertebral Artery

Figure

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  Fig. 1 Postoperative images of the anteroposterior X-ray images of the C1 lateral mass and C2 pedicle screw fixation. A : Unilateral. B : Bilateral.

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