The Results and Complications of the C1-C2 Transarticular Screw Fixation Methods.

Choi, Jun Woong; Yoon, Seung Hwan; Park, Hyung Chun; Park, Hyeon Seon; Kim, Eun Young; Ha, Yoon

Original Article

Journal of Korean Neurosurgical Society 2005;37(3): 201-206.

Jun Woong Choi, Seung Hwan Yoon, Hyung Chun Park, Hyeon Seon Park, Eun Young Kim, Yoon Ha

Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea. nsysh@inha.ac.kr

ABSTRACT

OBJECTIVE
To evaluate the accuracy and safety of C1-C2 transarticular screw insertion, we retrospectively review surgical records and postoperative radiological findings.
METHODS
From January 2001 to October 2003, the C1-C2 transarticular screw fixation and posterior wiring with iliac bone grafts was performed in 16 pateints. 6 patients had rheumatoid arthritis which caused cervical instability, 3 patients had os odontoideum, 3 patients had type 2 odontoid process fracture, 3 patients had traumatic transverse ligament injury and 1 patients who had been managed with C1-C2 wire fixation had psoriatic arthritis.
RESULTS
Osseous fusion was documented in 15 patients(93.8%). Only one patient was recorded screw loosening because of postoperative infection. One patient had only one screw placed because of abnormal anatomical structure, one patients was breakage of a Kirschner wire, and one screw was medial location to lateral mass of C1, but clinical results was excellent and radiological instability was not noted. CONCLUSION: The author's experience demonstrates that C1-C2 transarticular screw fixation with wired bone graft is a safe procedure with higher fusion rate but precaution is needed to avoid the neural damage, vertebral artery injury, and hardware failure.

Key Words: Posterior C1-C2 transarticular screw fixation; C1-C2 instability; Rheumatoid arthritis; Os odontoideum; Psoriatic arthritis