Three-point atlantoaxial fixation with C1–C2 transarticular screws and C1 lateral mass screws

Abstract

Background: Based on established posterior atlantoaxial fixation techniques, we present a novel technique that uses a polyaxial screw rod system and utilizes a combination of C1 lateral mass and C1–C2 transarticular screws. Methods: We conducted a retrospective review of six men and four women (mean age: 57, range: 20–86). Indication for atlantoaxial fixation was type II odontoid fractures or pseudarthrosis after odontoid fracture (n = 7), rheumatoid arthritis (n = 2) and os odontoideum (n = 1). Results: The mean follow-up time was 48 months (range: 24–72). There were no intraoperative complications such as vertebral artery, nerve root or spinal cord injury. Post-operative imaging showed no screw malposition. During follow-up, no patient had screw loosening, screw fracture or bone absorption around the screws. Clinically, patient neck pain improved in all cases. Conclusions: C1 lateral mass and C1–C2 transarticular polyaxial screw rod fixation is a novel and potentially effective surgical technique for achieving immediate rigid immobilization of the C1–C2 motion segment. However, further biomechanical studies should be performed to prove our clinical results.