C1-C2 fixation with C1 lateral mass and C2 pars screws, a case series technique and outcomes

Abstract

Background: Atlantoaxial fixation can be done either trans-orally, through the anterior retropharyngeal route, laterally or posteriorly. The posterior approach is the most frequently utilized. Posterior fusion with C1 lateral mass screws and C2 pars screws has been shown to produce better clinical outcomes than posterior C1/C2 wiring. In addition, it is safer than the C1 lateral mass-C2 pedicle screw construct (Goel-Harms technique) and biomechanically as strong.
Objective: To describe the results of a case series of C1-C2 fixation via C1 lateral mass and C2 Pars screws for traumatic C1-C2 injuries at AIC Kijabe Hospital and Nakuru Teaching and Referral Hospital in Kenya.
Design: This was a retrospective review of prospectively collated data between 2016 and 2019.
Methods: All the eight patients, with an average age of 37 years, were followed up for at least six months after surgery; and all had C1-C2 instability secondary to significant trauma. There were six male and two female patients. The ASIA Impairment Scale and Oswestry Neck Disability Index were
the clinical outcome measuring tools. Radiographically, plain X-rays and/or CT scan were used to assess radiologic union.
Results: Clinically, no patient deteriorated and all (100%) attained ASIA Scale E. On the Oswestry Neck Disability Index grading, there was no disability in one (12.5%) and minimal disability in seven (87.5%). All (100%) of the patients attained radiographic union. There was one (12.5%) acute deep infection in a diabetic patient.
Conclusion: The use of C1 lateral mass screws and C2 pars screws is safe and effective for fixation of C1-C2 instability.