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Unilateral C1 Lateral Mass and C2 Pedicle Screw Fixation for Atlantoaxial Instability in Rheumatoid Arthritis Patients: Comparison with the Bilateral Method.
- Source :
-
Journal of Korean Neurosurgical Society [J Korean Neurosurg Soc] 2015 Jun; Vol. 57 (6), pp. 460-4. Date of Electronic Publication: 2015 Jun 30. - Publication Year :
- 2015
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Abstract
- Objective: Bilateral C1 lateral mass and C2 pedicle screw fixation (C1LM-C2P) is an ideal technique for correcting atlantoaxial instability (AAI). However, the inevitable situation of vertebral artery injury or unfavorable bone structure may necessitate the use of unilateral C1LM-C2P. This study compares the fusion rates of the C1 lateral mass and C2 pedicle screw in the unilateral and bilateral methods.<br />Methods: Over five years, C1LM-C2P was performed in 25 patients with AAI in our institute. Preoperative studies including cervical X-ray, three-dimensional computed tomography (CT), CT angiogram, and magnetic resonance imaging were performed. To evaluate bony fusion, measurements of the atlanto-dental interval (ADI) and CT scans were performed in the preoperative period, immediate postoperative period, and postoperatively at 1, 3, 6, and 12 months.<br />Results: Unilateral C1LM-C2P was performed in 11 patients (44%). The need to perform unilateral C1LM-C2P was due to anomalous course of the vertebral artery in eight patients (73%) and severe degenerative arthritis in three patients (27%). The mean ADI in the bilateral group was 2.09 mm in the immediate postoperative period and 1.75 mm in 12-months postoperatively. The mean ADI in the unilateral group was 1.82 mm in the immediate postoperative period and 1.91 mm in 12-months postoperatively. Comparison of ADI measurements showed no significant differences in either group (p=0.893), and the fusion rate was 100% in both groups.<br />Conclusion: Although bilateral C1LM-C2P is effective for AAI from a biomechanical perspective, unilateral screw fixation is a useful alternative in patients with anatomical variations.
Details
- Language :
- English
- ISSN :
- 2005-3711
- Volume :
- 57
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Journal of Korean Neurosurgical Society
- Publication Type :
- Academic Journal
- Accession number :
- 26180616
- Full Text :
- https://doi.org/10.3340/jkns.2015.57.6.460