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Outcomes Following Arthrodesis for Atlanto-Axial Osteoarthritis

Kang, Daniel G. MD; Lehman, Ronald A. Jr. MD; Wagner, Scott C. MD; Peters, Colleen MA; Riew, K. Daniel MD

doi: 10.1097/BRS.0000000000001783

Study Design. Retrospective analysis.

Objective. We set out to evaluate the radiographic and patient-reported outcomes following C1-C2 arthrodesis for atlantoaxial osteoarthritis (AAOA) using modern instrumentation and techniques.

Summary of Background Data. Few studies have evaluated outcomes following C1-C2 arthrodesis for AAOA using modern surgical fixation techniques.

Methods. Retrospective analysis of all patients following C1-C2 arthrodesis with recalcitrant AAOA from a single center, single surgeon from 2002 to 2012. Preoperative, immediate and final follow-up postoperative radiographic images were evaluated. Patient-reported outcomes scores were assessed preoperative, 1-year, and final postoperative follow-up.

Results. We found a total of 14 patients (13 female, 1 male) with average follow-up of 2.96 ± 2.26 years and mean age at surgery of 71.8 ± 9.3 years old. The most common construct was posterior C1-C2 bilateral screw-rod construct (SRC) (n = 9), and there were 3 patients with transarticular screw (TAS) constructs, and 2 patients with hybrid fixation (unilateral SRC and contralateral TAS). Mean change from baseline to final follow-up for Numeric Pain Rating Scale (NRS) was −4.7 ± 2.1, and Neck Disability Index (NDI) was −21.0 ± 13.6, with 11 (78.6%) patients demonstrated a substantial clinical benefit (change in NDI ≥ 10). There were no differences from baseline to all follow-up time points for SF-12 Physical and Mental Component Scores. All patients had evidence of solid C1-C2 arthrodesis and stable fixation at final follow-up, with no significant change in subaxial sagittal alignment. There were no perioperative or postoperative complications.

Conclusion. We report one of the largest series evaluating patient-reported outcomes in patients following arthrodesis for AAOA using modern C1-C2 fixation techniques. Our study found C1-C2 arthrodesis for AAOA to be safe and effective, with a significant improvement in patient-reported pain and neck disability and most patients reporting substantial clinical benefit.

Level of Evidence: 4

*Department of Orthopedic Surgery, Madigan Army Medical Center, Tacoma, WA

Department of Orthopedic Surgery, Columbia University Medical Center—The Spine Hospital, New York, NY

Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD

§Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO.

Address correspondence and reprint requests to Daniel G. Kang, MD, Madigan Army Medical Center, Department of Orthopedic Surgery, 9040 Jackson Ave, Tacoma, WA 98431; e-mail:

Received 2 February, 2016

Revised 20 May, 2016

Accepted 23 June, 2016

The views expressed in this manuscript are those of the authors and do not reflect the official policy of the Department of Army, Department of Defense, or U.S. Government. Authors are employees of the United States government. This work was prepared as part of their official duties and as such, there is no copyright to be transferred.

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.

Relevant financial activities outside the submitted work: consultancy, grants, royalties, stocks, payment for lectures.

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