Atlantoaxial transarticular screw fixation and posterior fusion using polyester cable: a 10-year experience

Abstract

Purpose: To retrospective review the clinical outcomes of the modified operative technique using a polyester suture material (Ethibond* Excel) for atlantoaxial transarticular screw fixation and posterior fusion.

Methods: The retrospective reviews were conducted from 2002 to 2012. The patient's medical record reviews included demographic data, cause of atlantoaxial instability, orthopedic and surgical history, clinical presentation, radiographic finding including plain radiography, complications, operative detail, and outcome of treatment. Fusion of C1-C2 was defined as either graft consolidation or absence of C1-C2 movement on lateral flexion-extension radiograph.

Results: Twenty-three patients demonstrated clinical and radiographic evidence of atlantoaxial instability (13 men and 10 women, with a mean age of 42 years). Majority of atlantoaxial instability was caused by trauma. Most common clinical symptom was neck pain with or without cervical myelopathy. Bilateral screws were placed in 18 of the 23 patients. Five patients underwent placement of unilateral screws. The 13 patients were inserted by screws with diameter 4.0 mm. The means screw length was 40.33 mm. The means of operative time and estimated blood loss were 3.6 h and 234 ml, respectively. The mean of follow-up duration was 18 months. All 41 screws were positioned satisfactorily in C1 lateral mass. All 23 patients achieved fusion (100% fusion rate). After a period of follow-up, 9 of the 10 neurological deficit patients had completely recovered.

Conclusions: We concluded that the atlantoaxial transarticular screw fixation and posterior fusion using polyester cable can be used for C1-2 fusion with a high fusion rate and less complications in various cases.

Fig. 1

Drawing showing the step by step for application and tightening of two Ethibond* Excel suture materials with bone graft to atlantoaxial cervical spine. a The first suture was applied by Gallie technique without bone graft. b Transarticular screws were inserted with bone graft. c Tighten of bone graft by second Ethibond suture according to modified Gallie technique

Fig. 2

Imaging and intra-operative photograph before and after atlantoaxial transarticular screw fixation and posterior fusion using our modified technique. a Preoperative plain radiograph showed atlantoaxial subluxation. b Intra-operative photograph demonstrated the bone graft tightened by Ethibond suture material. c Nine months postoperatively, radiograph showed osseous fusion at C1–C2. d Two years 10 months postoperatively, T2 MRI showed no reaction such as fibrous tissue in area of Ethibond suture material