Clinical Outcome Analysis of Posterior C1 and C2 Screw Rod Fixation (Harms–Goel Technique) in Traumatic Atlantoaxial Dislocation

Abstract

Aims Evaluation of clinical profile, mode of injury, and clinical outcome in patients of traumatic atlantoaxial dislocation (AAD) who underwent posterior C1 and C2 screw and rod fixation by using Harms and Goel technique.

Materials and Methods It is a retrospective study involving all traumatic AAD patients of all age groups admitted at Department of Neurosurgery, RMLIMS, Lucknow, during the last two years. Inclusion criteria was all cases having traumatic AAD with or without C2 fracture and underwent posterior C1 and C2 screw and rod fixation by Harms and Goel technique. Clinical profile, age, sex, mode of injury, types of injury (detected in MRI and CT of cranio-vertebral junction), preoperative and postoperative (after one month of surgery) neurological status were evaluated and outcome analyzed.

Results Over all, out of 14 patients, 12 (85.7%) patients improved in the form of either reduced spasticity, improved sensation, increased power of one or more limbs, or bladder and bowel control. One (7.1%) patient retained preoperative status, neither improved nor deteriorated. However, one (7.1%) patient deteriorated, lost all sensations, motor functions below the lesion, bladder and bowel control, and died due to respiratory failure after one and half month of the surgery.

Conclusion We concluded that Harms and Goel technique is a safe and effective system for achieving C1–C2 fusion in traumatic AAD. Although this study is very small, does not provide Class 1 data, and is subject to the bias of any retrospective series, we believe our findings to be a useful addition to the body of literature on the surgical treatment of C1–C2 instability.

Keywords

atlantoaxial dislocation - Harms and Goel technique - C2 fracture - C1–C2 fusion

• References

• 1 Naderi S, Crawford NR, Song GS, Sonntag VK, Dickman CA. Biomechanical comparison of C1-C2 posterior fixations. Cable, graft, and screw combinations. Spine 1998; 23 (18) 1946-1955
• 2 Nakanishi T, Sasaki T, Takahata T. et al. Internal fixation of odontoid fracture. Chubu Nihon Seikei Geka Saigai Geka Gakkai Zasshi 1980; 23: 399-406
• 3 Apfelbaum RI, Lonser RR, Veres R, Casey A. Direct anterior screw fixation for recent and remote odontoid fractures. J Neurosurg 2000; 93 (Suppl. 02) 227-236
• 4 Brooks AL, Jenkins EB. Atlanto-axial arthrodesis by the wedge compression method. J Bone Joint Surg Am 1978; 60 (03) 279-284
• 5 Abou Madawi A, Solanki G, Casey AT, Crockard HA. Variation of the groove in the axis vertebra for the vertebral artery. Implications for instrumentation. J Bone Joint Surg Br 1997; 79 (05) 820-823
• 6 Gorek J, Acaroglu E, Berven S, Yousef A, Puttlitz CM. Constructs incorporating intralaminar C2 screws provide rigid stability for atlantoaxial fixation. Spine 2005; 30 (13) 1513-1518
• 7 Pryputniewicz DM, Hadley MN. Axis fractures. Neurosurgery 2010; 66 (Suppl. 03) 68-82
• 8 Harms J, Melcher RP. Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine 2001; 26 (22) 2467-2471
• 9 Goel A, Desai KI, Muzumdar DP. Atlantoaxial fixation using plate and screw method: a report of 160 treated patients. Neurosurgery 2002; 51 (06) 1351-1356
• 10 Goel A, Kulkarni AG, Sharma P. Reduction of fixed atlantoaxial dislocation in 24 cases: technical note. J Neurosurg Spine 2005; 2 (04) 505-509
• 11 Goel A, Pareikh S, Sharma P. Atlantoaxial joint distraction for treatment of basilar invagination secondary to rheumatoid arthritis. Neurol India 2005; 53 (02) 238-240
• 12 Goel A, Shah A. Atlantoaxial joint distraction as a treatment for basilar invagination: a report of an experience with 11 cases. Neurol India 2008; 56 (02) 144-150
• 13 Chen JF, Wu CT, Lee SC, Lee ST. Posterior atlantoaxial transpedicular screw and plate fixation. Technical note. J Neurosurg Spine 2005; 2 (03) 386-392
• 14 Magerl F, Seemann PS. Stable posterior fusion at the atlas and axis by transarticular screw fixation. In: Kehr P, Weidner A. eds. Cervical Spine I. Vienna: Springer-Verlag; 1987: 322-327
• 15 Neo M, Sakamoto T, Fujibayashi S, Nakamura T. The clinical risk of vertebral artery injury from cervical pedicle screws inserted in degenerative vertebrae. Spine 2005; 30 (24) 2800-2805
• 16 Mixter SJ, Osgood RB. Traumatic instability of the atlas and axis. Ann Surg 1910; 51 (02) 193-207
• 17 Coyne TJ, Fehlings MG, Wallace MC, Bernstein M, Tator CH. C1-C2 posterior cervical fusion: long-term evaluation of results and efficacy. Neurosurgery 1995; 37 (04) 688-692
• 18 Majercik S, Tashjian RZ, Biffl WL, Harrington DT, Cioffi WG. Halo vest immobilization in the elderly: a death sentence?. J Trauma 2005; 59 (02) 350-356 discussion 356–358
• 19 Bloch O, Holly LT, Park J, Obasi C, Kim K, Johnson JP. Effect of frameless stereotaxy on the accuracy of C1-2 transarticular screw placement. J Neurosurg 2001; 95 (01) Suppl 74-79
• 20 Farey ID, Nadkarni S, Smith N. Modified Gallie technique versus transarticular screw fixation in C1-C2 fusion. Clin Orthop Relat Res 1999; (359) 126-135
• 21 Madawi AA, Casey AT, Solanki GA, Tuite G, Veres R, Crockard HA. Radiological and anatomical evaluation of the atlantoaxial transarticular screw fixation technique. J Neurosurg 1997; 86 (06) 961-968
• 22 Melcher RP, Puttlitz CM, Kleinstueck FS, Lotz JC, Harms J, Bradford DS. Biomechanical testing of posterior atlantoaxial fixation techniques. Spine 2002; 27 (22) 2435-2440
• 23 Paramore CG, Dickman CA, Sonntag VK. The anatomical suitability of the C1-2 complex for transarticular screw fixation. J Neurosurg 1996; 85 (02) 221-224
• 24 Stokes JK, Villavicencio AT, Liu PC, Bray RS, Johnson JP. Posterior atlantoaxial stabilization: new alternative to C1-2 transarticular screws. Neurosurg Focus 2002; 12 (01) E6
• 25 Stulik J, Vyskocil T, Sebesta P, Kryl J. Atlantoaxial fixation using the polyaxial screw-rod system. Eur Spine J 2007; 16 (04) 479-484
• 26 Menendez JA, Wright NM. Techniques of posterior C1-C2 stabilization. Neurosurgery 2007; 60 (01) (Suppl. 01) S103-S111
• 27 Geremia GK, Kim KS, Cerullo L, Calenoff L. Complications of sublaminar wiring. Surg Neurol 1985; 23 (06) 629-635
• 28 Wright NM. Translaminar rigid screw fixation of the axis. Technical note. J Neurosurg Spine 2005; 3 (05) 409-414
• 29 Aryan HE, Newman CB, Nottmeier EW, Acosta Jr FL, Wang VY, Ames CP. Stabilization of the atlantoaxial complex via C-1 lateral mass and C-2 pedicle screw fixation in a multicenter clinical experience in 102 patients: modification of the Harms and Goel techniques. J Neurosurg Spine 2008; 8 (03) 222-229
• 30 Hott JS, Lynch JJ, Chamberlain RH, Sonntag VK, Crawford NR. Biomechanical comparison of C1-2 posterior fixation techniques. J Neurosurg Spine 2005; 2 (02) 175-181
• 31 Kuroki H, Rengachary SS, Goel VK, Holekamp SA, Pitkänen V, Ebraheim NA. Biomechanical comparison of two stabilization techniques of the atlantoaxial joints: transarticular screw fixation versus screw and rod fixation. Neurosurgery 2005; 56 (Suppl. 01) 151-159 discussion 151–159