Retrospective comparative study.
To compare the outcomes of C1-C2 transarticular screw
with C1 laminar hook
(TAS + C1H) fixation
and C1 trans-arch lateral mass screw
with C2 pedicle screw
(C1TLMS + C2PS) fixation
in the treatment of reducible atlantoaxial dislocation
Summary of Background Data.
TAS + C1H is comparable to TAS with posterior wiring techniques and superior to C1 lateral mass screw
combined with C2 pedicle screw
(C1LMS + C2PS) in biomechanics. There were, however, few studies analyzing the differences in outcomes between TAS + C1H technique and modified C1LMS + C2PS technique (C1TLMS + C2PS) for treating AAD.
Data of 30 patients with reducible AAD treated by TAS + C1H fixation
and another 30 cases treated by C1TLMS + C2PS fixation
were retrospectively analyzed. Bone fusion
time was recorded. The outcomes evaluated by American Spinal Injury Association impairment scale, visual analog scale score for neck pain, neck stiffness (none/mild/severe), patient satisfaction, and Neck Disability Index (NDI) were compared between two groups.
There were no complications related to the surgical approach and instrumentation in either group. At the final follow-up, bone graft fusion
rates were 100% in both the TAS + C1H fixation
group and the C1TLMS + C2PS fixation
> 0.05). The neurological status evaluated by American Spinal Injury Association impairment scale were greatly improved in both screw-hook
< 0.001) and screw-rod group (P
< 0.001), but with no significant differences between groups (P
> 0.05). There were no significant differences between two groups in visual analog scale score for neck pain, neck stiffness, patient satisfaction, or Neck Disability Index (all P
C1TLMS + C2PS fixation
was comparable to TAS + C1H fixation
rate and functional outcomes for treating reducible AAD. To reduce the risk of vertebral artery injury, computed tomography scan, and reconstruction should be done to analyze vertebral artery course and C1-C2
anatomic structures before operation.
Level of Evidence: 3