Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications, and lessons learned in 191 adult patients

Update item information
Publication Type Journal Article
School or College School of Medicine
Department Neurosurgery
Creator Schmidt, Meic H.; Apfelbaum, Ronald I.
Other Author Gluf, Wayne M.
Title Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications, and lessons learned in 191 adult patients
Date 2005
Description Object. In this, the first of two articles regarding C1-2 transarticular screw fixation, the authors assessed the rate of fusion, surgery-related complications, and lessons learned after C1-2 transarticular screw fixation in an adult patient series. Methods. The authors retrospectively reviewed 191 consecutive patients (107 women and 84 men; mean age 49.7 years, range 17-90 years) in whom at least one C1-2 transarticular screw was placed. Overall 353 transarticular screws were placed for trauma (85 patients), rheumatoid arthritis (63 patients), congenital anomaly (26 patients), os odontoideum (four patients), neoplasm (eight patients), and chronic cervical instability (five patients). Among these, 67 transarticular screws were placed in 36 patients as part of an occipitocervical construct. Seventeen patients had undergone 24 posterior C1-2 fusion attempts prior to referral. The mean follow-up period was 15.2 months (range 0.1-106.3 months). Fusion was achieved in 98% of cases followed to commencement of fusion or for at least 24 months. The mean duration until fusion was 9.5 months (range 3-48 months). Complications occurred in 32 patients. Most were minor; however, five patients suffered vertebral artery (VA) injury. One bilateral VA injury resulted in patient death. The others did not result in any permanent neurological sequelae. Conclusions. Based on this series, the authors have learned important lessons that can improve outcomes and safety. These include techniques to improve screw-related patient positioning, development of optimal instrumentation, improved screw materials and design, and defining the role for stereotactic navigation. Atlantoaxial transarticular screw fixation is highly effective in achieving fusion, and the complication rate is low when performed by properly trained surgeons.
Type Text
Publisher American Association of Neurological Surgeons (AANS)
First Page 155
Last Page 163
Subject Atlantoaxial junction; Craniocervical junction; Instability; Transarticular screw fixation; Fusion
Subject LCSH Bone screws (Orthopedics); Spine -- Surgery; Spinal fusion
Subject MESH Atlanto-Axial Joint; Spinal Fusion
Language eng
Bibliographic Citation Gluf, W. M., Schmidt, M. H., & Apfelbaum, R. I. (2005). Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications, and lessons learned in 191 adult patients. Journal of Neurosurgery: Spine, 2, 155-63.
Rights Management (c) American Association of Neurological Surgeons
Format Medium application/pdf
Format Extent 335,018 bytes
Identifier ir-main,12783
ARK ark:/87278/s6cn7n8k
Setname ir_uspace
Date Created 2012-06-13
Date Modified 2012-06-13
ID 705043
Reference URL https://collections.lib.utah.edu/ark:/87278/s6cn7n8k
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