Posterior fixation and fusion with atlas pedicle screw system for upper cervical diseases

• Published in: Chinese journal of traumatology Vol. 11; no. 6; pp. 323 - 328
• Main Author: 李雷 周凤华 王欢 崔少千
• Format: Journal Article
• Language: English
• Published: China Elsevier B.V 01.12.2008; Department of Orthopaedics, Sheng-jing Hospital,China Medical University, Shenyang110004, China
• Subjects: Adult; Bone Screws; Cervical Atlas - diagnostic imaging; Cervical Atlas - injuries; Cervical Atlas - pathology; Cervical Atlas - surgery; Feasibility Studies; Female; Fracture fixation; Fracture Fixation, Internal - instrumentation; Humans; Joint Dislocations - diagnostic imaging; Joint Dislocations - surgery; Male; Middle Aged; Odontoid Process - abnormalities; Odontoid Process - diagnostic imaging; Odontoid Process - pathology; Odontoid Process - surgery; Spinal Fractures - diagnostic imaging; Spinal Fractures - surgery; Spinal Fusion - instrumentation; Spinal Neoplasms - diagnostic imaging; Spinal Neoplasms - pathology; Spinal Neoplasms - surgery; Tomography, X-Ray Computed; Treatment Outcome; 断裂固定; 治疗方法; 稳定性; Atlas; Fracture fixation; Bone screws
• ISSN: 1008-1275
• DOI: 10.1016/S1008-1275(08)60066-8

Objective： To evaluate the feasibility, safety and efficacy of atlas pedicle screws system fixation and fusion for the treatment of upper cervical diseases. Methods： Twenty-three consecutive patients with upper cervical disorders requiring stabilization, including 19 cases of atlantoaxial dislocation （4 congenital odontoid disconnections, 6 old odontoid fractures, 4 fresh odontoid fractures of Aderson Ⅱ C, 3 ruptures of the C1 transverse ligament, and 2 fractures of C1）, 2 cases of C2 tumor （instability after the resection of the tumors）, and 2 giant neurilemomas of C2-C3（instability after resection of the tumors）, were treated by posterior fixation and fusion with the atlas pedicle screw system, in which the screws were inserted through the posterior arch of C1. The operative time, bleeding volume and complications were reported. All patients were immobilized without external fixation or with rigid cervical collars for 1-3 months. All patients were followed up and evaluated with radiographs and CT. Results： In the 23 patients, 46 C1 pedicle screws, 42 C2 pedicle screws and 6 lower cervical lateral mass screws and 2 lower cervical pedicle screws were placed. The mean operative time and bleeding volume was 2.7 hours and 490 ml respectively. No intraoperative complications were directly related to surgical technique. No neurological, vascular or infective complications were encountered. All patients were followed up for 3-36 months （average 15 months）. Firm bony fusion was documented in all patients after 3-6 months. One patient with atlas fracture showed anterior occipitocervical fusion. There was no implant failure. Conclusions： Posterior fixation and fusion of the atlas pedicle screw system is feasible and safe for the treatment of upper cervical diseases, and may be applicable to a larger number of patients.