Transversal cancellous bone plastic and ventral temporary atlantoaxial fixation in the treatment of dens pseudarthrosis

Purpose: According to literature there is a pseudarthrosis rate of about 1% up to 64% depending on the treatment of the dens fracture (16). Generally the treatment of dens pseudarthrosis consists of the fusion of the joint C1 /C2 with or without dens resection. Now, a method is presented whereby, on the one hand the pseudarthrosis is treated, while on the other hand the ana tomical structures and physiological function of the joint C1/C2 are restor ed. Method: The operation consits of a gradual outboring of the base of the dens and the dens axis and filling with autologous cancellous bone. Then f ollows a lateral, temporary transarticular screw fixation of C1/C2 which gu arentees an immobilisation of the filled out dens. A halo-body-jacket is th en applied. The removal of the screws of the temporary fixation follows thr ee months post operatively after X-ray control. Then physiotherapy of the c ervical spine follows. Results: During 7/93 and 7/97 this operation was car ried out on 11 patients. In 9 cases compression screw osteosynthesis was pr imarily conducted and in 2 cases conservative therapy had preceded. The X-r ay follow ups showed on an average of 14 mounth a stable bony fusion in 10 patients, the clinical follow up examinations on an average of 14 month a n ormal function. Conclusion: The operation presented is indicated in case of dens pseudarthrosis because this accomplished a definite bony fusion witho ut disturbance of the function of the joint C1/C2 in patients not older tha n 60 years. Disadvantages are to be found in the intraoperatively high X-ra y radiation and the 3 month immobilisation.