The Comparison Between Transarticular Screw Fixation and Segmental Screw-Rod Fixation for Posterior Fusion of the C1-2 Segment: A Systematic Review and Meta-Analysis

Abstract

Both transarticular screw fixation (TAS) and segmental screw-rod fixation (SF) have been widely performed for C1-2 fusion; however, just only small clinical studies and a few meta-analyses comparing the 2 surgical techniques for C1-2 posterior fusion have been reported. We searched the Cochrane, Embase, and Medline databases for articles comparing the intraoperative and postoperative outcomes of TAS and SF for C1-2 posterior fusion with April 14, 2022, as the publication cutoff date. The odds ratio (OR) and standardized mean difference were used to analyze differences in outcomes between the 2 abovementioned surgical techniques. A P value<0.05 was considered statistically significant. A total of 5101 publications were assessed, and 6 studies were finally included in the study. In terms of the fusion rate, SF produced significantly better outcomes than TAS did (OR=2.96, P=0.02). With respect to surgical outcomes, blood loss and operation times were significantly lower in the TAS group than those in the SF group (P=0.008 and P<0.00001, respectively). The rate of vertebral artery injury was significantly lower in the SF group than that in the TAS group (OR=3.95, P=0.04). However, other complications, such as screw malposition, infection, hardware failure, and nonunion, were not significantly different between the 2 groups. SF showed a greater fusion rate and lower risk of vertebral artery injury than TAS did, but TAS showed less blood loss and lower operation times than SF.