Radiographic Analysis of Atlantoaxial Fusion for Atlantoaxial Instability -Comparison of Posterior wiring, Transarticular screw, Posterior screw-rod fixation - (환축추 불안정성에 대한 환축추 유합술의 방사선학적 분석 - 후방 강선, 경관절 나사, 후방 나사-강봉 고정술의 비교 -)

정재윤; Hyoung-Yeon Seo (서형연); 김기형; LEE GUN-WOO (이건우)

Radiographic Analysis of Atlantoaxial Fusion for Atlantoaxial Instability -Comparison of Posterior wiring, Transarticular screw, Posterior screw-rod fixation -

Journal of Korean Society of Spine Surgery
Abbr : J Kor Spine Sur
2010, 17(4), pp.157-163
Publisher : Korean Society Of Spine Surgery
Research Area : Medicine and Pharmacy > Orthopedic Surgery

정재윤 ¹, Hyoung-Yeon Seo ², 김기형 ², LEE GUN-WOO ²

¹전남대학교
²전남대학교병원

Accredited

ABSTRACT

Study Design: This is a retrospective study. Objectives: We wanted to clarify the association between the position of the atlantoaxial fusion angle and the change of the subaxial cervical spine alignment (SCA) and the reduction loss after atlantoaxial fusion (AAF) using the posterior wiring technique (PWT),transarticular screw fixation (TAF) and posterior screw-rod fixation (PSR) for treating atlantoaxial instability (AAI). Summary of the Literature Review: There are not many studies on the change of the SCA and the reduction loss after AAF. Material and Methods: Thirty five patients underwent AAF for AAI from 1986 to 2008. The mean follow-up period was 59.5 months. The surgical techniques were divided into three groups, that is, PWT: 17 patients, TAS: 10 and PSR: 8. The causes of instability were transverse ligament rupture in 12 patients, rheumatoid arthritis in 11, Os odontoideum in 6 and nonunion of an odontoid fracture in 6. Plain radiographs were used to assess the atlanto-dental interval, the posterior arch-lamina angle, the change of the SCA and the time of fusion. Results: Fusion was achieved in all the patients within 3.5 months (range: 3-5 months). The radiologic findings in the 5 PWT patients showed a reduction loss and 3 patients showed subaxial cervical kyphosis (SCK). The TAS group had no reduction loss or SCK. The PSR group had no reduction loss and one patient showed SCK. A statistically significant reduction loss and SCK occurred in the group in which there was a posterior arch-laminar angle greater than 10 degrees before and after surgery. Conclusions: For the treatment of AAI, the position of the AAF is associated with the change of the postoperative SCA. The preoperative lodortic position of C1-2 should be maintained to prevent the change of the SCA

KEYWORDS

Atlantoaxial instability, Atlantoaxial fusion, Subaxial cervical spine alignment

Citation status

* References for papers published after 2023 are currently being built.

[journal] Song KW / 2000 / Posterior Atlantoaxial Fusion of the Unstable Cervical Spine / J Kor Soc Spine Surg 7 : 474~476

[journal] Gallie WE / 1939 / Fractures and dislocations of the cervical spine / Am J Surg 46 : 495~499

[journal] Brooks AL / 1978 / Atlanto-axial arthrodesis by the wedge compression method / J Bone Joint Surg Am 60 : 279~284

[book] Margel F / 1987 / Stable posterior fusion of the atlas and axis by transarticular screw fixation. Cervical spine, 1sted / Springer-Verlag : 322~327

[journal] Harms J / 2001 / Posterior C1-C2 Fusion With Polyaxial Screw and Rod Fixation / Spine 26 : 2467~2471

[journal] Mechler RP / 2002 / Biomechanical testing of posterior atlantoaxial fixationtechnique / Spine 27 : 2435~2440

[journal] Mukai Y / 2007 / Sagittal alignment of the subaxial cervical spine after C1-C2 transarticular screw fixation in rheumatoid arthritis / J Spinal Disord Tech 20 : 436~441

[journal] Chang H / 1997 / Posterior Atlantoaxial Fusion with Posterior Wiring : Analysis of 19 Cases / J Kor Soc Spine Surg 4 : 257~264

[journal] Mukai Y / 2004 / A retrospective radiographic analysis of subaxial sagittal alignment after posterior C1-2 fusion / Spine 29 : 175~181

[journal] Matsunnaga S / 2001 / Significance of occipitoaxial angle in subaxial lesion after occipitocervical fusion / Spine 26 : 161~165

[journal] Nolan JP / 1988 / Biomechanical evaluation of the extensor musculature of the cervical spine / Spine 13 : 9~11

[journal] Iizuka H / 2001 / Extensor musculature of the cervical spine after laminoplasty: morphologic evaluation by coronal view of the magnetic resonance image / Spine 26 : 2220~2226

[journal] Yoshimoto H / 2004 / A retrospective radiographic analysis of subaxial sagittal alignment after posterior C1-2 fusion / Spine 29 : 175~181

[journal] Dickman CA / 1995 / Surgical management of atlantoaxial nonunions / J Neurosurgery 83 : 248~253

[journal] Crawford NR / 1999 / Differential biomechanical effects of injury and wiring at C1-2 / Spine 24 : 1894~1902

[journal] Mimatsu K / 1992 / Atlantoaxial fusion with posterior double wire fixation / Spine 17 : 1409~1413

[journal] Matoshi S / 1997 / Atlantoaxial dislocation : A Follow-up study of surgical results / Spine 22 : 759~763

KJCKorea
Journal Central

Journal of Korean Society of Spine Surgery 2023 KCI Impact Factor : 0.03