Safety and Efficacy of Harms' Technique in the Management of Atlantoaxial Instability. A Single Institution Experience and Review of the Literatures

Abstract

Introductionvarious procedures for the management of atlantoxial instability have reviewed in the literatures. Advantages and disadvantages of these procedures have been stressed. Harms' procedure is one of the recently introduced techniques. This is a retrospective descriptive clinical case study to evaluate the safety and efficacy of Harms' technique. Patients and Methodswe reviewed our hospital medical records between 2009 and 2014. We were able to track 19 patients treated for atlantoaxial instability using Harms' technique with complete records. Patients' mean age was 19.6 years. Twelve were males and 7 were females. Surgical indications included: atlantoaxial ligamentous instability in 2, Os Odentadium in 2, Downs' syndrome in 3, type-II dens fracture in 5, atlantoaxia rotatory fixation in 7. All patients had plain radiography, CT scan, and MRI. According to the JOA-score 15 were normal, 3 were grade-1 and one was grade-2. All patients were operated with Hams' technique with iliac Bone graft. The following factors were evaluated; age, sex, pathology, neurological status, operative time, blood loss, hospital stay, morbidity, screw purchases, stability, fusion, and clinical outcome. Resultsmean operative time was 125 minute. Mean blood loss was 350 ml. Hospital stay was 4 days. Screw purchase was adequate in all cases but one. Stability was adequate in all. Fusion was sound in all but two. All intact patients remained intact. Other patients improved at least one grade on JOA-Score. One patient had vertebral artery perforation by a low seated screw. There were no added neurological deficits in any of our patients. Conclusionour experience demonstrates the safety and efficacy of the Harms' technique in the management of atlantoaxial instability. Meticulous technique and anatomical knowledge are mandatory for optimizing outcome.