C1-C2 Transarticular screw fixation for atlantoaxial instability

The atlantoaxial segment of the cervical spine is commonly destabilized in a variety of disorders. Transarticular screw fixation of the C1-C2 joint has been proposed as a biomechanically superior therapeutic modality. The authors present their experience with this technique. A retrospective analysis of 23 patients treated with this technique was performed. The mean follow-up period was 39.5 +/- 0.1 months. Mean duration of hospitalization was 3.4 +/- 0.1 days (range, 2 to 11 days). No intraoperative or early postoperative complications were detected. Four patients (17.4%) had postoperative complications unrelated to the primary procedure. The position of the screw was judged as satisfactory in 21 patients (91.3%). Two patients (8.7%) with suboptimal positioning of the screws were neurologically intact but needed no reoperation. Solid osseous fusion was detected in 19 patients (82.6%). Transarticular C1-C2 screw fixation appears to be a safe and surgically reliable technique. Criteria for its application and refinements in its technical considerations continue to advance its clinically versatile therapeutic potential.