Fluoroscopy-Assisted C1-C2 Posterior Fixation for Atlantoaxial Instability: A Single-Center Case Series of 78 Patients.

Charles Tatter,Alexander Fletcher-Sandersjöö,Adrian Elmi-Terander,Oscar Persson,Erik Edström,Gustav Burström

doi:10.3390/medicina58010114

Charles Tatter, Alexander Fletcher-Sandersjöö + Show 4 more

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https://doi.org/10.3390/medicina58010114

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Abstract

Background and Objectives: Posterior C1–C2 fixation, with trans-articular screws (TAS) or screw-rod-construct (SRC), is the main surgical technique for atlantoaxial instability, and can be performed with a fluoroscopy-assisted free-handed technique or 3D navigation. This study aimed to evaluate complications, radiological and functional outcome in patients treated with a fluoroscopy-assisted technique. Materials and Methods: A single-center consecutive cohort study was conducted of all adult patients who underwent posterior C1–C2 fixation, using TAS or CRS, between 2005–2019. Results: Seventy-eight patients were included, with a median follow-up time of 6.8 years. Trauma was the most common injury mechanism (64%), and cervicalgia the predominant preoperative symptom (88%). TAS was used in 33%, and SRC in 67% of cases. Surgery was associated with a significant reduction in cervicalgia (from 88% to 26%, p < 0.001). The most common complications were vertebral artery injury (n = 2, 2.6%), and screw malposition (n = 5, 6.7%, of which 2 were TAS and 3 were SRC). No patients deteriorated in their functional status following surgery. Conclusions: Fluoroscopy-assisted C1–C2 fixation with TAS or SRC is a safe and effective treatment for atlantoaxial instability, with a low complication rate, few surgical revisions, and pain relief in the majority of the cases.

Highlights

Atlantoaxial instability can be caused by odontoid fractures, arthritis and cervical tumors [1,2,3,4]
Trauma was the most common surgical indication (n = 50, 64%), while 9 (12%) cases were treated for rheumatic instability, 3 (3.8%) cases for odontoid-related instability, 2 (2.6%) for pseudarthrosis despite previous surgery and the remaining 14 (18%) for other degenerative atlantoaxial disorders
Twenty-seven of the trauma patients were treated with acute C1–C2 stabilization within the first week from the trauma, while the remaining 23 trauma patients were initially treated conservatively but later converted to surgical treatment due to increased instability and cervicalgia

Summary

Introduction

Atlantoaxial instability can be caused by odontoid fractures, arthritis and cervical tumors [1,2,3,4]. Many centers still use non-navigated, fluoroscopy-guided techniques for atlantoaxial fixations. Posterior C1–C2 fixation, with trans-articular screws (TAS) or screw-rod-construct (SRC), is the main surgical technique for atlantoaxial instability, and can be performed with a fluoroscopy-assisted free-handed technique or 3D navigation. This study aimed to evaluate complications, radiological and functional outcome in patients treated with a fluoroscopyassisted technique. The most common complications were vertebral artery injury (n = 2, 2.6%), and screw malposition (n = 5, 6.7%, of which 2 were TAS and 3 were SRC). Conclusions: Fluoroscopyassisted C1–C2 fixation with TAS or SRC is a safe and effective treatment for atlantoaxial instability, with a low complication rate, few surgical revisions, and pain relief in the majority of the cases

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