A Retrospective Clinical Results And Radiographic Analysis After Posterior C1-C2 Fusion

Objective: A retrospective review of patients undergoing C1-C2 fusionfor nonneoplastic disease was carried out at ChangZheng Hospital of SMMU from 1995 to 2003. with the aim of determining the long-term outcome of the selected procedures, in an effort to establish any relationship between the outcome of the fusion technique used and the cause of the C1-C2 instability.Study Design: About one hundre and ninety-five patients underwentposterior atlantoaxial fusion procedures from 1995 to 2003 in ChangZheng Hospital of SMMU, 92 patients were success for Retrospectiving. with a mean follow-up of 4. 2 years (range, 2. 0 - 8. 2 yr). The most common disease processes were odontoid fracture (47 patients), transverse atlantal ligament injury (12 patients), os odontoideum (21 patients), insufficiency of atlantoaxial ligament (2 patients), and rheumatoid C1-C2 instability (10 patients).Summary of Background Data: wiring techniques are the mostcommonly used methods of achieving C1-C2 arthrodesis. Recently, transarticular screw fixation and interlaminar clamping have been advocated to achieve more secure fixation.Methods: 92 patients with A-A subluxation who underwent severaltypes of posterior A~A fusion were involved. There were 54 women and 38 men. The methods of posterior fusion consisted of Gallie' s wire in 50,Brooks wiring in 28, Magerl procedure in 3, Magerl procedure with posterior wiring in 5, and Apofix clamp in 5.Results: 5 (5.4%) of Gallie/Brooks fusions failed. These occurred withos odontoideum (4 patients), odontoid fracture (1 patients), and 1 of Apofix clamp fusions failed with transverse atlantal ligament injury. All transarticular screw procedures resulted in successful fusions. 3 procedures (3.2%) resulted in new neurological deficit; both of these patients underwent posterior wiring for os odontoideum.Conclusions: This study suggests that odontoid fractures may besuccessfully managed by a posterior wiring technique alone. Rheumatoid C1-C2 instability may be managed by posterior wiring supplemented with halo immobilization. Transarticular screw fixation has several potential advantages as a technique for C1-C2 arthrodesis and, in particular, may be appropriate for os odontoideum that had a high failure rate with conventional posterior wiring, even when this was supplemented with bracing.