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Bilateral Atlantoaxial Transarticular Screws and Atlas Laminar Hooks Fixation for Pediatric Atlantoaxial Instability

Ni, Bin, MD; Guo, Xiang, MD; Xie, Ning, MD; Lu, Xuhua, MD; Yuan, Wen, MD; Li, Songkai, MD; Zhou, Fengjing, MD; Zhu, Zhuangchen, MD

doi: 10.1097/BRS.0b013e3181e8ee87
Cervical Spine

Study Design. An atlantoaxial fixation using bilateral C1–C2 transarticular screws and C1 laminar hooks was used in 5 pediatric patients, who were then followed up for 12 to 17 months to evaluate the technique.

Objective. To describe a modified posterior C1–C2 fixation technique and preliminary clinical and radiographic results in 5 pediatric patients.

Summary of Background Data. Conventional posterior atlantoaxial fixations, such as Gallie and Brooks techniques, are frequently associated with high rates of pseudarthrosis and implant failure. The C1–C2 transarticular screw fixation has been shown to be effective in treatment of pediatric atlantoaxial instability, as well as adult atlantoaxial instability; however, this 2-point fixation merely stabilizes the atlantoaxial motion segment laterally. A 3-point fixation, composed with bilateral C1–C2 transarticular screws and C1 laminar hooks, has been developed.

Methods. Five patients with atlantoaxial instability, including 4 males and 1 female, aged 6 to 17 (average 10) years, underwent atlantoaxial fixation using bilateral C1–C2 transarticular screws and C1 laminar hooks during a 2-year period. The surgical technique and treatment procedures were intensively reviewed, and clinical symptoms and imaging appearance were retrospectively evaluated.

Results. Clinical follow-ups were obtained for an average of 14.4 (range: 12–17) months. The clinical and radiologic follow-up indicated a stable arthrodesis and offered clinical relief from symptoms for all patients. No neural or vascular impairment related to this technique was observed.

Conclusion. Fixation of the atlantoaxial articulation using bilateral C1–C2 transarticular screws and C1 laminar hooks appears to be a reliable technique for treatment of pediatric atlantoaxial instability.

A 3-point fixation combined with C1–C2 transarticular screws provided better biomechanical stability than 1- or 2-point fixation. Under the condition of a thorough preoperative preparation, this modified fixation is an effective treatment for pediatric atlantoaxial instability.

From the Department of Orthopedics, The Second Affiliated Hospital, Second Military Medical University, Shanghai, People's Republic of China.

Acknowledgment date: December 3, 2009. First revision date: March 23, 2010. Second revision date: May 4, 2010. Acceptance date: May 10, 2010.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

B.N. and X.G. contributed equally to the article.

Address correspondence and reprint requests to Bin Ni, MD, Department of Orthopedics, Changzheng Hospital, 415 Fengyang Rd, Shanghai, People's Republic of China; E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.