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KMID : 1143720100060020143
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Korean Journal of Neurotrauma
2010 Volume.6 No. 2 p.143 ~ p.149
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Atlantoaxial Transpedicular Screw Fixation for the Management of Traumatic Upper Cervical Spone Instability
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Kim Byung-Sub
Yoo Do-Sung
Huh Phil-Woo
Cho Kyoung-Suok
Lee Sang-Bok
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Abstract
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Objective:The morbidity and mortality are high for traumatic upper cervical spine instability with cervico-medullary compression. In a clinical retrospective study, the clinical and radiographic results of occipitocervical (OC) fusion using posterior atlantoaxial transpedicular screw fixation in 12 patients with traumatic upper cervical spine instability was reviewed.
Methods:Twelve patients with traumatic upper cervical spine instability (8 males and 4 females) were treated at our department over four years. Instability resulted from acute C1-C2 dislocation (4 cases), an acute unstable C2 fracture (1 case), acute C1-2-3 fracture dislocation (2 cases), acute C1 fracture (1 case), OC dislocation (2 cases) and old unstable C2 fracture (1 case). All 12 patients were internally fixed with occipital-/C1-C2 transpedicular screw fixation. The outcome (mean follow-up period, 16.5 months) was based on clinical and radiographic review using the Japanese Orthopedic Association (JOA) score.
Results:Four neurologically intact patients remained the same after surgery. Among eight patients with cervical myelopathy, clinical improvement was noted in six cases (75%). The JOA score of the 8 patients were 9.4 (range, 0-16) before surgery and 12.1 (range, 0-17) with a recovery rate of 38.3% at the time of the last follow up. One patient died 2 months after the surgery because of pneumonia and sepsis. Fusion was achieved in 10 patients (90.9%) by the last follow-up.
Conclusion:Early OC fusion is recommended in cases with traumatic upper cervical spinal instability, OC fusion with posterior atlantoaxial transpedicular screw fixation was a safe and effective method for the treatment of traumatic cervical spine instability.
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KEYWORD
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Atlantoaxia fixation, Occipitocervical fusion, Transpedicular screw fixation
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