Unilateral C1 Lateral Mass and C2 Pedicle Screw Fixation for Atlantoaxial Instability in Rheumatoid Arthritis Patients : Comparison with the Bilateral Method

Title
Unilateral C1 Lateral Mass and C2 Pedicle Screw Fixation for Atlantoaxial Instability in Rheumatoid Arthritis Patients : Comparison with the Bilateral Method
Authors
전형준
Keywords
Atlantoaxial; Bilateral; C1-2; Harm's Technique; Instability; Unilateral
Issue Date
2015-06
Publisher
KOREAN NEUROSURGICAL SOC
Citation
JOURNAL OF KOREAN NEUROSURGICAL SOCIETY, v. 57, NO 6, Page. 460-464
Abstract
Objective : Bilateral Cl lateral mass and C2 pedicle screw fixation (C1LM-C2P) is an ideal technique for correcting atlantoaxial instability (All). 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 Cl lateral mass and C2 pedicle screw in the unilateral and bilateral methods. Methods : Over five years, C1LM-C2P was performed in 25 patients with All 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. Results : Unilateral Cl LM-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. Conclusion : Although bilateral Cl LM-C2P is effective for AAI from a biomechanical perspective, unilateral screw fixation is a useful alternative in patients with anatomical variations.
URI
http://jkns.or.kr/journal/view.php?doi=10.3340/jkns.2015.57.6.460http://hdl.handle.net/20.500.11754/25104
ISSN
2005-3711; 1598-7876
DOI
http://dx.doi.org/10.3340/jkns.2015.57.6.460
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COLLEGE OF MEDICINE[S](의과대학) > MEDICINE(의학과) > Articles
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