Atlantoaxial fixation using the polyaxial screw–rod system |
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Authors: | Jan Stulik Tomas Vyskocil Petr Sebesta Jan Kryl |
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Institution: | (1) Spine Surgery Department, Teaching Hospital Prague Motol, Prague 5, Czech Republic |
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Abstract: | The aim of this study is to evaluate the first results of the atlantoaxial fixation using polyaxial screw–rod system. Twenty-eight
patients followed-up 12–29 months (average 17.1 months) were included in this study. The average age was 59.5 years (range
23–89 years). The atlantoaxial fusion was employed in 20 patients for an acute injury to the upper cervical spine, in 1 patient
with rheumatoid arthritis for atlantoaxial vertical instability, in 1 patient for C1–C2 osteoarthritis, in 2 patients for
malunion of the fractured dens. Temporary fixation was applied in two patients for type III displaced fractures of the dens
and in two patients for the atlantoaxial rotatory dislocation. Retrospectively, we evaluated operative time, intraoperative
bleeding and the interval of X-ray exposure. The resulting condition was subjectively evaluated by patients. We evaluated
also the placement, direction and length of the screws. Fusion or stability in the temporary fixation was evaluated on radiographs
taken at 3, 6, 12 weeks and 6 and 12 months after the surgery. As concerns complications, intraoperatively we monitored injury
of the nerve structures and the vertebral artery. Monitoring of postoperative complications was focused on delayed healing
of the wound, breaking or loosening of screws and development of malunion. Operative time ranged from 35 to 155 min, (average
83 min). Intraoperative blood loss ranged from 50 to 1,500 ml (average 540 ml). The image intensifier was used for a period
of 24 s to 2 min 36 s (average 1 min 6 s). Within the postoperative evaluation, four patients complained of paresthesia in
the region innervated by the greater occipital nerve. A total of 56 screws were inserted into C1, their length ranged from
26 to 34 mm (average, 30.8 mm). All screws were positioned correctly in the C1 lateral mass. Another 56 screws were inserted
into C2. Their length ranged from 28 to 36 mm (average 31.4 mm). Three screws were malpositioned: one screw perforated the
spinal canal and two screws protruded into the vertebral artery canal. C1–C2 stability was achieved in all patients 12 weeks
after the surgery. No clinically manifested injury of the vertebral artery or nerve structures was observed in any of these
cases. As for postoperative complications, we recorded wound dehiscence in one patient. The Harms C1–C2 fixation is a very
effective method of stabilizing the atlantoaxial complex. The possibility of a temporary fixation without damage to the atlantoaxial
joints and of reduction after the screws and rods had been inserted is quite unique. |
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Keywords: | Atlantoaxial fixation Spine surgery Atlantoaxial instability |
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