A Comparison of the Long-term Results of Posterior Transarticular Stand-alone Screw Instrumentation and Magerl Technique in Patients with Traumatic Atlantoaxial Instability: Mean 5-Year Follow-Up Study with a Radiological and Patient-rated Outcomes Assessment.

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A Comparison of the Long-term Results of Posterior Transarticular Stand-alone Screw Instrumentation and Magerl Technique in Patients with Traumatic Atlantoaxial Instability: Mean 5-Year Follow-Up Study with a Radiological and Patient-rated Outcomes Assessment.

World Neurosurg. 2019 Feb 16;:

Authors: Lvov I, Grin A, Talypov A, Kordonskiy A, Sytnik A, Khushnazarov U, Smirnov V, Krylov V

Abstract
PURPOSE: To perform a radiological analysis of the degeneration of C1-C2 joints following C1-C2 transarticular fixation (TAF), and compare the long-term results of a routine Magerl technique (RMT) to a posterior transarticular С1-С2 stand-alone screw instrumentation (SAS) application.
MATERIALS AND METHODS: Forty patients (26 men and 14 women) were included in this retrospective observational cohort study. The mean follow-up period was 61.7 months (range: 11-118). The mean age of patients at the control examination was 48.4 years (range: 22-82). Eleven patients were included in the RMT group and 29 were included in the SAS group.
RESULTS: The structure of 80 atlantoaxial joints (AAJs) was analysed, among which Grade 4 degenerative changes were observed in 57 joints (71.3%). Out of 40 analysed, atlanto-odontoid joints (AOJs) following Grade 4 degenerative changes were revealed in 18 joints (45%). C1-C2 bone fusion was observed in 38 patients (95%) and stable fibrous fusion in 2 patients (5%). No cases of C1-C2 nonunion were revealed. No statistically significant differences in frequency of C1-C2 fracture consolidation or C1-C2 fusion development were revealed between the RMT and SAS groups.
CONCLUSIONS: The application of cortical lag screws in TAF may result in stable AAJ fusion formation without joint curettage. AOJ fusion may be observed after C1-C2 TAF. The application of cortical lag screws for bilateral fixation using the SAS technique resulted in C1-C2 fusion formation in 93,1% of cases, which is comparable with Magerl technique.

PMID: 30780035 [PubMed - as supplied by publisher]

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