Cervical Hooks for Atlanto-Axial Posterior Cervical Fusion, IBRAHIUM M. IBRAHIUM, SAMEH SAKR, MOHAMED ADEL ELMALLAWANY
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- Category: Vol. 83, March 2015
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Cervical Hooks for Atlanto-Axial Posterior Cervical Fusion, IBRAHIUM M. IBRAHIUM, SAMEH SAKR, MOHAMED ADEL ELMALLAWANY
Abstract
Introduction: Treatment of atlantoaxial instability is predominantly surgical aiming at stabilization, bony union, improvement of pain and neurological status and restoration of normal anatomy of atlantoaxial joint.
Purpose: The present study was designed to determine the surgical yield of cervical C1-C2 fixation by implantation of C1-C2 laminar hook systems via posterior approach for the treatment of patients with C1-C2 instability.
Patients and Methods: The present study included 20 patients; assigned for C1-C2 fusion for non-neoplastic disease; diagnosis and inclusion was confirmed by magnetic resonance imaging (MRI). The applied technique for C1-C2 hook fixation was conducted, using either iliac crest or artificial bone graft. Postoperative bracing (firm collar) was applied for 8-12 weeks. Outcome Measures included radiological evaluation of suc-cessful bone fusion, neurological evaluation using the American Spinal Injury Association (ASIA) motor score, neck and arm pain scoring, neck disability index (NDI) and the functional independence measure (FIM) presented as total motor score. Evaluations were conducted preoperatively and at end of follow-up period of at least 6 months.
Results: The study included 11 patients with odontoid fracture, 3 transverse atlantal ligament injuries, 4 as odonto-ideum and 2 had rheumatoid C1-C2 instability. Preoperative neurological evaluation detected 8 patients were ASIA grade B, 7 were ASIA grade C and 5 patients were ASIA grade D. All surgeries were conducted smoothly without intraoperative complications and an autogenous iliac crest graft was applied in 18 patients, while artificial bone grafts were used in 2 patients. Radiological examinations conducted at end of follow-up period at least 6 months showed evidence of fusion in 65%. Postoperative clinical evaluation revealed significant improvement of neurological ASIA grading and 35% showed complete recovery without motor or sensory deficit. Both pain and neck disability scores was decreased postoperatively compared to preoperative scores. Postoperative total FMI motor power scoring was higher compared to preoperative measures.
Conclusion: Posterior C1-C2 fixation using hooks system is technically simple to apply and can be done safely without
concomitant intra-or postoperative complications. High success rates in obtaining fusion and significant improvement at the end of follow-up with high quality-of-life scores make this method of posterior fixation and fusion an optimal surgical modality for higher cervical spine instability which can be executed without any risk of vertebral injury.