Minimally Invasive Posterior Transarticular Stand-Alone Screw Instrumentation of C1–C2 Using a Transmuscular Approach: Description of Technique, Results and Comparison with Posterior Midline Exposure

Abstract

The aim of this study was to compare the feasibility, safety, and fusion results of posterior transarticular stand-alone screw (SAS) instrumentation of C1-C2 with a minimally invasive technique to those of a posterior midline exposure. Between 2008 and 2016, 164 patients underwent surgical treatment for traumatic injuries to the upper cervical vertebrae at our institution. We included 38 patients (27 men and 11 women; age range, 17-81 years) in the study. The posterior midline approach (PMA) group (23 patients) included patients who underwent surgery by means of a conventional midline incision after percutaneous screw insertion. The transmuscular approach (TMA) group (15 patients) included patients who underwent SAS fixation by use of a minimally invasive technique. The mean follow-up period was 58 months (range, 12-118 months). Statistical analysis revealed that the operative time, blood loss volume, and severity of postoperative pain were lower in the TMA group. No significant excess of radiation exposure to the surgical team and the patients occurred in TMA group compared with the PMA group. C1-C2 fusion was observed in 37 patients. Stable fibrous fusion between the C1 and C2 vertebrae was found in 1 patient. A minimally invasive technique by use of a paravertebral transmuscular approach provides an alternative to routine posterior transarticular SAS fixation of C1 and C2 through a posterior midline approach. The minimally invasive technique reduces the duration of surgery and the volume of blood loss, decreases the severity of postoperative pain, and does not increase the amount of radiation exposure for the surgical team and the patient.