Insights into the past and future of atlantoaxial stabilization techniques

Abstract

Over the past century, atlantoaxial stabilization techniques have improved considerably. To our knowledge there has been a scarcity of articles published that focus specifically on the history of atlantoaxial stabilization. Examining the history of instrumentation allows us to evaluate the impact of early influences on current modern stabilization techniques. It also provides inspiration to further develop the techniques and prevents repetition of mistakes. This paper reviews the evolution of C1–C2 instrumentation techniques over time and provides insights into the future of these practices. We did an extensive literature search in PubMed, Embase and Google Scholar, using the following search terms: ‘medical history’, ‘atlantoaxial’, ‘C1/C2’, ‘stabilization’, ‘instrumentation’, ‘fusion’, ‘arthrodesis’, ‘grafting’, ‘neuroimaging’, ‘biomechanical testing’, ‘anatomical considerations’ and ‘future’. Many different entry zones have been tested, as well as different constructs, from initial attempts with use of silk threads to use of hooks and rod–wire techniques, and handling of bone grafts, which eventually led to the development of the advanced screw–rod constructs that are currently in use. Much of this evolution is attributable to advancements in neuroimaging, a wide range of new materials available and an improvement in biomechanical understanding in relation to anatomical structures.