European Spine Journal

, Volume 22, Issue 7, pp 1564–1569 | Cite as

Atlantoaxial transarticular screw fixation and posterior fusion using polyester cable: a 10-year experience

  • Werasak SutipornpalangkulEmail author
  • Surin Thanapipatsiri
Original Article



To retrospective review the clinical outcomes of the modified operative technique using a polyester suture material (Ethibond* Excel) for atlantoaxial transarticular screw fixation and posterior fusion.


The retrospective reviews were conducted from 2002 to 2012. The patient’s medical record reviews included demographic data, cause of atlantoaxial instability, orthopedic and surgical history, clinical presentation, radiographic finding including plain radiography, complications, operative detail, and outcome of treatment. Fusion of C1–C2 was defined as either graft consolidation or absence of C1–C2 movement on lateral flexion–extension radiograph.


Twenty-three patients demonstrated clinical and radiographic evidence of atlantoaxial instability (13 men and 10 women, with a mean age of 42 years). Majority of atlantoaxial instability was caused by trauma. Most common clinical symptom was neck pain with or without cervical myelopathy. Bilateral screws were placed in 18 of the 23 patients. Five patients underwent placement of unilateral screws. The 13 patients were inserted by screws with diameter 4.0 mm. The means screw length was 40.33 mm. The means of operative time and estimated blood loss were 3.6 h and 234 ml, respectively. The mean of follow-up duration was 18 months. All 41 screws were positioned satisfactorily in C1 lateral mass. All 23 patients achieved fusion (100 % fusion rate). After a period of follow-up, 9 of the 10 neurological deficit patients had completely recovered.


We concluded that the atlantoaxial transarticular screw fixation and posterior fusion using polyester cable can be used for C1–2 fusion with a high fusion rate and less complications in various cases.


Atlantoaxial instability Polyester cable Transarticular screw fixation 



The authors thank the residents and other staff of the Siriraj Orthopedic department for their assistance in the operation. This study is supported by Siriraj Research Development Fund, Faculty of Medicine Siriraj Hospital, Mahidol University.

Conflict of interest

The authors confirm that there is no conflict of interest in the preparation of this article.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Werasak Sutipornpalangkul
    • 1
    Email author
  • Surin Thanapipatsiri
    • 1
  1. 1.Department of Orthopaedic Surgery, Faculty of MedicineSiriraj Hospital, Mahidol UniversityBangkoknoiThailand

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