Clinical Outcome Analysis of Posterior C1 and C2 Screw Rod Fixation (Harms–Goel Technique) in Traumatic Atlantoaxial Dislocation

Abstract

Aims Evaluation of clinical profile, mode of injury, and clinical outcome in patients of traumatic atlantoaxial dislocation (AAD) who underwent posterior C1 and C2 screw and rod fixation by using Harms and Goel technique.Materials and Methods It is a retrospective study involving all traumatic AAD patients of all age groups admitted at Department of Neurosurgery, RMLIMS, Lucknow, during the last two years. Inclusion criteria was all cases having traumatic AAD with or without C2 fracture and underwent posterior C1 and C2 screw and rod fixation by Harms and Goel technique. Clinical profile, age, sex, mode of injury, types of injury (detected in MRI and CT of cranio-vertebral junction), preoperative and postoperative (after one month of surgery) neurological status were evaluated and outcome analyzed.Results Over all, out of 14 patients, 12 (85.7%) patients improved in the form of either reduced spasticity, improved sensation, increased power of one or more limbs, or bladder and bowel control. One (7.1%) patient retained preoperative status, neither improved nor deteriorated. However, one (7.1%) patient deteriorated, lost all sensations, motor functions below the lesion, bladder and bowel control, and died due to respiratory failure after one and half month of the surgery.Conclusion We concluded that Harms and Goel technique is a safe and effective system for achieving C1–C2 fusion in traumatic AAD. Although this study is very small, does not provide Class 1 data, and is subject to the bias of any retrospective series, we believe our findings to be a useful addition to the body of literature on the surgical treatment of C1–C2 instability.