Anterior transarticular screw fixation for atlantoaxial arthrodesis: A report of two cases

• Main Authors: C S Carrier, A A Sama, F P Girardi, D R Lebl
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2013-01-01
• Series: Journal of Craniovertebral Junction and Spine
• Subjects: Anterior approach; atlantoaxial instability; C1-C2 fixation; transarticular screw fixation
• Online Access: http://www.jcvjs.com/article.asp?issn=0974-8237;year=2013;volume=4;issue=2;spage=85;epage=89;aulast=Carrier

The sequelae of atlantoaxial instability (AAI) range from axial neck pain to life-threatening neurologic injury. Instrumentation and fusion of the C1-2 joint is often indicated in the setting of clinical or biomechanical instability. This is the first clinical report of anterior Smith-Robinson C1-2 transarticular screw (TAS) fixation for AAI. The first patient presented with ischemic brain tissue secondary to post-traumatic C1-2 segment instability from a MVC 7 years prior to presentation. The second patient presented with a 3 year history of persistent right-sided neck and upper scalp pain. Both were treated with transarticular C1-2 fusion through decortication of the atlantoaxial facet joints and TAS fixation via the anterior Smith-Robinson approach. At 16 months follow-up, the first patient maintained painless range of motion of the cervical spine and denied sensorimotor deficits. The second patient reported 90% improvement in her pre-operative symptoms of neck pain and paresthesia. Anterior Smith-Robinson C1-2 TAS fixation provides a useful alternative to the posterior Goel and Magerl techniques for C1-2 stabilization and fusion.