C1–C2 transarticular screw fixation for treatment of C1–C2 instability

Abstract

C1–C2 instability has traditionally been treated by C1–C2 posterior wiring and bone grafting. However, this technique has an incidence of non-union which may exceed 10%. Transarticular screw fixation has developed as a technique of providing increased strength of fixation of C1–C2 arthrodesis, while at the same time avoiding the need for postoperative halo bracing and avoiding the risk of neurological injury associated with the passage of sublaminar wires. We present a retrospective review of 12 patients with C1–C2 instability treated by C1–C2 transarticular screw fixation. Eight patients underwent this procedure as primary treatment, and 4 after a failed Gallie fusion. Five patients had a cruciate ligament rupture, 5 had an odontoid process fracture, 1 had os odontoideum, and 1 had rheumatoid instability. There was no surgical morbidity or mortality and, at a mean follow up of 12.1 ± 3 months (range 8–14 months), all patients had achieved solid fusion, and all neurological symptoms referable to the instability had resolved. C1–C2 transarticular screw fixation has been shown to be safe and effective and has a number of advantages when compared to traditional posterior wiring techniques. We recommend that this technique be considered as a primary treatment of C1–C2 instability.