Combined Magerl Technique With Intraoperative Release For The Treatment Of Traumatic Atlantoaxial Instability

Objectives:To evaluate the feasibility and efficacy of combined Magerl technique with intraoperative release for the treatment of traumatic atlantoaxial instability.Methods. From January2007to December2010,35patients with incompletely-reduced atlantoaxial instability were treated with bilateral C1-2posterior transarticular screw fixation, of these, all of cases with C1posterior arch intact underwent one-stage Magerl surgery combined with C1-2posterior Gallie surgery. These patients’ clinical outcomes postoperative CT scan was performed to assess the instrumentation. Short term and long term efficacy and complications were recorded.Results:All patients underwent surgery successfully, without severe complications such as injury of nerve or blood vessels, neurological function improved remarkably. All patients were followed up for6～33months(mean,18.8months). C1-2dislocation(anteriorly and laterally) was evidenced radiographily in some patients no screw perforation was documented. The atlanto-occipital joint was kept intact in all cases. All patients got C1-2bony fusion within3to6months postoperatively.Conclusions:Combined Magerl technique with intraoperative release can be feasible and safe for patients with incompletely-reduced atlantoaxial instability. Atlantoaxial joint is not completely reset, as long as they meet the exact fixed, and completely reset cases, no significant difference in clinical outcomes.