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  • Title: Bilateral atlantoaxial transarticular screws and atlas laminar hooks fixation for pediatric atlantoaxial instability.
    Author: Ni B, Guo X, Xie N, Lu X, Yuan W, Li S, Zhou F, Zhu Z.
    Journal: Spine (Phila Pa 1976); 2010 Nov 15; 35(24):E1367-72. PubMed ID: 21030894.
    Abstract:
    STUDY DESIGN: An atlantoaxial fixation using bilateral C1-C2 transarticular screws and C1 laminar hooks was used in 5 pediatric patients, who were then followed up for 12 to 17 months to evaluate the technique. OBJECTIVE: To describe a modified posterior C1-C2 fixation technique and preliminary clinical and radiographic results in 5 pediatric patients. SUMMARY OF BACKGROUND DATA: Conventional posterior atlantoaxial fixations, such as Gallie and Brooks techniques, are frequently associated with high rates of pseudarthrosis and implant failure. The C1-C2 transarticular screw fixation has been shown to be effective in treatment of pediatric atlantoaxial instability, as well as adult atlantoaxial instability; however, this 2-point fixation merely stabilizes the atlantoaxial motion segment laterally. A 3-point fixation, composed with bilateral C1-C2 transarticular screws and C1 laminar hooks, has been developed. METHODS: Five patients with atlantoaxial instability, including 4 males and 1 female, aged 6 to 17 (average 10) years, underwent atlantoaxial fixation using bilateral C1-C2 transarticular screws and C1 laminar hooks during a 2-year period. The surgical technique and treatment procedures were intensively reviewed, and clinical symptoms and imaging appearance were retrospectively evaluated. RESULTS: Clinical follow-ups were obtained for an average of 14.4 (range: 12-17) months. The clinical and radiologic follow-up indicated a stable arthrodesis and offered clinical relief from symptoms for all patients. No neural or vascular impairment related to this technique was observed. CONCLUSION: Fixation of the atlantoaxial articulation using bilateral C1-C2 transarticular screws and C1 laminar hooks appears to be a reliable technique for treatment of pediatric atlantoaxial instability.
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