[Transarticular C1-C2 screw fixation: results of unstable odontoid fractures and pseudarthrosis in the elderly]

Abstract

Background: Transarticular dorsal screw fixation of atlantoaxial instability in the elderly is seldom described in the literature. This study presents the results of this technique in patients aged at least 70 years. A modified method of indirect screw fixation is used in which soft tissue dissection is reduced compared to the classic procedure.

Patients and methods: Between 1998 and 2005 a total of 36 patients with acute or chronic traumatic instability of the atlantoaxial complex were treated surgically. The average age was 80.1 years (70-93 years). Seven patients (19.4%) had associated injuries. The operative technique was standard. The duration of radiological follow-up averaged 23 months (12-57 months) whereas clinical follow-up was for 38 months (12-72 months).

Results: There were no intraoperative complications. Of the total 72 screws inserted, 2 (2.8%) proved to be incorrectly positioned. There were complications not associated with the procedure in 16 patients (44.4%). Nosocomial infections and falls were the most common complications. Two deaths occurred within the first postoperative month. Four more patients died in the follow-up period as a result of diseases not associated with the trauma. Of the 30 surviving patients, 28 (93.3%) were followed up clinically and radiologically. Bony dorsal fusion was documented in every patient followed up. Further operation on the cervical spine was not required in any patient.

Conclusion: The presented technique of transarticular C1-C2 screw fixation is associated with reliable fusion rates and good functional results. The procedure can be recommended for atlantoaxial instability in the elderly.