Posterior transpedicular screw internal fixation with bone grafts fusion for atlantoaxial instability / 中华创伤杂志

ABSTRACT

Objective To investigate the clinical value and relating problems in treating atlantoaxial instability by using transpedicular instrumentation with fusion. Methods The study reviewed 18 patients (11 males and 7 females, at age range of 13-82 years, mean 46.5 years) with atlantoaxial instability undergone transpedicular screw internal fixation with bone grafts fusion. There were 15 patients with type Ⅱ odontoid fractures, two with traumatic disruption of transverse atlantal ligament and one with fracture of the anterior ring of C1, all of which were associated with atlantoaxial subluxation or obvious instability. Preoperative JOA score was 6-13 points (average 9.5 points). Results The operation lasted for mean 115 minutes (range 75-180 minutes), with intraoperative blood loss of mean 235 ml (range 130-450 ml). One patient presented intraoperative plexus venous bleeding during removal of lower edge of the posterior arch of atlas and was treated with hemostasis using compession of gelatin sponge. All the patients were followed up for a mean period of 13.5 months (6-38 months), which showed no complications including infection, loosening or breakage of internal fixators or neurovascular injury related to internal fixation. Postoperative JOA score was 12-17 points (average 14.5 points). Reduction and solid fusion of the bone graft were achieved satisfactorily in all patients. Conclusions Posterior transpedicular screw internal fixation with bone grafts fusion can achieve good reduction, reliable fixation, high fusion rate and is a reliable method to manage atlantoaxial instability. Correct selection of the indication, familiarity with local anatomy and mastery of the operation technique are key to a satisfactory curative effect.