C1-c2 transarticular screw fixation: Technical aspects

OBJECTIVE: I review posterior atlantoaxial fusion with transarticular screw fixation, including indications, complications, and operative technique, e mphasizing my experience. METHODS: The indications for C1-C2 transarticular screw fixation include tr aumatic injuries to the atlantoaxial complex, instability resulting from in flammatory disease (rheumatoid arthritis), and congenital abnormalities (os odontoideum). All patients underwent stabilization using cannulated C1-C2 t ransfacetal screws by the method described by Magerl. Supplemental interspi nous fusion with bicortical autologous iliac crest graft and titanium cable was used to restore the posterior tension band by use of the method descri bed by Sonntag's group. Preoperatively, all patients underwent imaging with plain radiographs, magnetic resonance imaging, and axial computed tomograp hy. Patients were maintained in a rigid cervical orthosis postoperatively. RESULTS: Measures used to improve safety and efficacy include patient posit ioning, fluoroscopic guidance, preoperative magnetic resonance imaging, axi al computed tomography, and open reduction of C1-C2 subluxation before scre w passage. In this series of 75 patients, fusion was obtained in 72 patient s (96%). There were no instances of vertebral artery injury, errant screw p lacement, instrumentation failure, dural laceration, spinal cord injury, or hypoglossal nerve injury. CONCLUSION: C1-C2 transarticular screw fixation with a posterior tension ba nd construct provides excellent fusion rates with few perioperative complic ations. Preoperative imaging and meticulous surgical technique improve outc omes.