Treatment of traumatic upper cervical instability with single posterior atlantoaxial pedicle screw system

Abstract

Objective To investigate the clinical efficacy of atlantoaxial pedicle screw fixation plus bony fusion in treatment of traumatic upper cervical instability. Methods From October 2009 to August 2013, 29 patients with traumatic upper cervical spine instability were treated with posterior atlantoaxial pedicle screws. The patients underwent autografting (n=19) and allografting (n=10) for spinal fusion. Surgical outcomes were recorded including intraoperative blood loss, operation time, with or without nerve, blood vessel and spinal cord injury, wound healing and bone fusion rate. Results All operations were completed smoothly with operation time of 110 minutes (range, 85-135 minutes) and blood loss of 150 ml (range, 80-500 ml). At the follow-up of 10 months to 5 years (mean 18 months), bony fusion was detected for all the patients. Postoperative radiographs verified all patients were bony fusion with satisfactory cervical spine stability. No complications of reduction loss, fixation failure, and spinal cord or vertebral artery injury were observed except for 1 patient with low virulent infection and 2 with delayed wound healing. Conclusion Single posterior atlantoaxial pedicle screw fixation provides security and reliable stability in treatment of upper cervical instability, however wound healing problems should be taken seriously. Key words: Axis; Spinal injuries; Pedicle screws