Unilateral Atlantoaxial Transpedicular Screw and Rod/Plate Fixation With Sublaminar Polyethylene Cable Fixation

Abstract

This report presents 2 of the cases of primary posterior unilateral atlantoaxial transpedicular screw and rod/plate fixation supplemented by a polyethylene cable as sublaminar wiring for the treatment of a patient with atlantoaxial subluxation. The patients had a unilateral high-riding vertebral artery at the axis, and a unilateral screw and rod/plate fixation with sublaminar fixation was performed to provide more rigid stabilization at the atlantoaxial junction. One patient with a delayed nonreducible odontoid fracture had a good outcome with a complete reduction and posterior fusion. The other elderly patient achieved a sufficient union at the fracture site of the odontoid process; however, resorption of the interlaminar grafting bone was observed. The stability of the unilateral transpedicular screw and rod/plate fixation with sublaminar polyethylene cable fixation might therefore be insufficient to obtain the fusion of the grafted bone in an osteoporotic elderly patient. Another procedure such as a laminar screw procedure should thus be considered for such a patient.