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Transarticular screw fixation for osteoarthritis of the atlanto axial segment

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Abstract

Atlantoaxial (C1–C2) facet joint osteoarthitis is a distinct clinical syndrome that often goes unrecognized. Severe pain resistant to conservative treatment that is corroborated by the radiographic findings represents the indication for surgery. The aim of this study was to retrospectively examine the long-term outcome [after an average 6.5 years (SD 4.0)] of C1-2 fusion for osteoarthritis of the atlantoaxial segment in 35 consecutive patients [25 male, 10 female; aged 62 (SD 15) years]. At follow-up, clinical outcome and radiological status was examined in 27/35 (77%) patients, and self-rated pain and disability (Neck Pain and Disability Scale; NPDS) in 29/35 (83%) patients. In 27/35 patients (77%), 2 screws were inserted; in 7 patients (20%), only 1 screw; and in 1 patient (3%), no screws. 11% of the patients had late complications requiring revision surgery. All patients showed solid fusion at the long-term follow-up. 26% patients showed an improvement in sensory disturbances, 63% no change, and 11% a worsening. 89% were pain-free or had markedly reduced pain. The average score on the NPDS (0–100) was 34 (SD 27), representing ‘mild’ neck problems, and the average pain intensity (0–5 VAS) was 1.5 (SD 1.5). Eighty-five percent of the patients declared that they would make the same decision again to undergo surgery. In conclusion, in a group of patients with a painful and debilitating degenerative disorder of C1-2, posterior transarticular atlantoaxial fusion proved to be an effective treatment with a low rate of serious complications.

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References

  1. Bogduk N, Marsland A (1988) The cervical zygapophysial joints as a source of neck pain. Spine 13:610–617

    CAS  PubMed  Google Scholar 

  2. Bremerich FH, Mannion AF, Baumgartner H, Grob D (2002) Transkulturelle Anpassung des “Neck Pain and Disability” Fragebogens für deutschsprachige Patienten. Jahreskongress der schweizerischen Gesellschaft für Orthopädie

  3. Brooks AL, Jenkins EG (1978) Atlanto-axial arthrodesis by the wedge compression method. J Bone Joint Surg 60-A:279–284

    Google Scholar 

  4. Chevrot A, Cermakova E, Vallee C, Chancelier MD, Chemla N, Rousselin B, Langer-Cherbit A (1995) C1-2 arthrography. Skelet Radiol 24:425–429

    Article  CAS  Google Scholar 

  5. Dickman CA, Sonntag VK (1998) Posterior C1-C2 transarticular screw fixation for atlantoaxial arthrodesis. Neurosurgery 43:275–280 (discussion 280–281)

    Google Scholar 

  6. Dvorak J, Antinnes JA, Panjabi MM, Loustalot D, Bonomo M (1992) Age and gender related normal motion of the cervical spine. Spine 17:S393–S398

    CAS  PubMed  Google Scholar 

  7. Dvorak J, Dvorak V (1991) Manuelle Medizin. 4. Auflage (Thieme Verlag, Stuttgart, New York

  8. Ehrat C, Grob D, Dvorak J (1996) Die posttraumatische atlantoaxiale arthrose. Der Orthopäde 25:542–545

    Article  CAS  PubMed  Google Scholar 

  9. Farey ID, Nadkarni S, Smith N (1999) Modified Gallie technique versus transarticular screw fixation in C1–C2 fusion. Clin Orthop 359:126–135

    Article  PubMed  Google Scholar 

  10. Gallie WE (1939) Fractures and dislocations of the cervical spine. Am J Surg 46-A:495–499

    Article  Google Scholar 

  11. Garvey TA, Transfeldt EE, Malcolm JR, Kos P (2002) Outcome of anterior cervical discectomy and fusion as perceived by patients treated for dominant axial-mechanical cervical spine pain. Spine 27:1887–1895 (discussion 1895)

    Article  PubMed  Google Scholar 

  12. Gerster JC, Doenz F (1994) Unusual destructive and hypertrophic arthropathy of the atlanto-axial joint in calcium pyrophosphate dihydrate deposition disease. Osteoarthritis Cartil 2:275–279

    CAS  Google Scholar 

  13. Glemarec J, Guillot P, Laborie Y, Berthelot JM, Prost A, Maugars Y (2000) Intraarticular glucocorticosteroid injection into the lateral atlantoaxial joint under fluoroscopic control. A retrospective comparative study in patients with mechanical and inflammatory disorders Joint Bone Spine 67:54–61

    CAS  PubMed  Google Scholar 

  14. Goffin J, Van Brussel K, Martens K, Vander Sloten J, Van Audekercke R, Smet MH (2001) Three-dimensional computed tomography-based, personalized drill guide for posterior cervical stabilization at C1–C2. Spine 15:1343–1347

    Article  Google Scholar 

  15. Gore DR (2001) Roentgenographic findings in the cervical spine in asymptomatic persons: a ten-year follow-up. Spine 26:2463–2466

    Article  CAS  PubMed  Google Scholar 

  16. Grob D (1998) Surgery in the degenerative cervical spine. Spine 23:2674–2683

    Article  CAS  PubMed  Google Scholar 

  17. Grob D, Crisco J, Panjabi M, Wang P, Dvorak J (1992) Biomechanical evaluation of four different posterior atlantoaxial fixation techniques. Spine 17:480–490

    CAS  PubMed  Google Scholar 

  18. Grob D, Magerl F (1987) Surgical stabilization of C1 and C2 fractures. Orthopade 16:46–54

    CAS  PubMed  Google Scholar 

  19. Halla JT, Hardin JG Jr (1987) Atlantoaxial (C1–C2) facet joint osteoarthritis: a distinctive clinical syndrome. Arthritis Rheum 30:577–582

    CAS  PubMed  Google Scholar 

  20. Harata S, Tohno S, Kawagishi T (1981) Osteoarthritis of the alanto-axial joint. Int Orthop 5:277–282

    Article  CAS  PubMed  Google Scholar 

  21. Kikuchi S, Macnab I, Moreau P (1981) Localisation of the level of symptomatic cervical disc degeneration. J Bone Joint Surg Br 63-B:272–277

    PubMed  Google Scholar 

  22. Kusakabe N, Tsuzuki N, Sonada M (1995) Compression of the cervical cord due to alcaptonuric arthropathy of the atlanto-axial joint. A case report. J Bone Joint Surg Am 77:274–277

    CAS  PubMed  Google Scholar 

  23. Madawi AA, Casey AT, Solanki GA, Tuite G, Veres R, Crockard HA (1997) Radiological and anatomical evaluation of the atlantoaxial transarticular screw fixation technique. J Neurosurg 86:961–968

    CAS  PubMed  Google Scholar 

  24. Neo M, Matsushita M, Yasuda T, Sakamoto T, Nakamura T (2002) Use of an aiming device in posterior atlantoaxial transarticular screw fixation. Technical note. J Neurosurg Spine 97:123–127

    Google Scholar 

  25. Reilly TM, Sasso RC, Hall PV (2003) Atlantoaxial stabilization: clinical comparison of posterior cervical wiring technique with transarticular screw fixation. J Spinal Disord Tech 16:248–253

    PubMed  Google Scholar 

  26. Song GS, Theodore N, Dickman CA, Sonntag VK (1997) Unilateral posterior atlantoaxial transarticular screw fixation. J Neurosurg 87:851–855

    CAS  PubMed  Google Scholar 

  27. Star MJ, Curd JG, Thorne RP (1992) Atlantoaxial lateral mass osteoarthritis. A frequently overlooked cause of severe occipitocervical pain. Spine 17:S71–S76

    CAS  PubMed  Google Scholar 

  28. Suchomel P, Stulik J, Klezl Z, Chrobok J, Lukas R, Krbec M, Magerl F (2004) [Transarticular fixation of C1-C2: a multicenter retrospective study]. Acta Chir Orthop Traumatol Cech 71:6–12

    CAS  PubMed  Google Scholar 

  29. Weidner A, Wahler M, Chiu ST, Ullrich CG (2000) Modification of C1–C2 transarticular screw fixation by image-guided surgery. Spine 25:2668–2673 (discussion 2674)

    Article  CAS  PubMed  Google Scholar 

  30. Wheeler AH, Goolkasian P, Baird AC, Darden BV II (1999) Development of the Neck Pain and Disability Scale. Item analysis, face, and criterion-related validity. Spine 24:1290–1294

    Article  CAS  PubMed  Google Scholar 

  31. Wlodyka-Demaille S, Poiraudeau S, Catanzariti JF, Rannou F, Fermanian J, Revel M (2002) French translation and validation of 3 functional disability scales for neck pain. Arch Phys Med Rehabil 83:376–382

    Article  PubMed  Google Scholar 

  32. Wlodyka-Demaille S, Poiraudeau S, Catanzariti JF, Rannou F, Fermanian J, Revel M (2004) The ability to change of three questionnaires for neck pain. Joint Bone Spine 71:317–326

    Article  PubMed  Google Scholar 

  33. Wright NM, Lauryssen C (1998) Vertebral artery injury in C1-2 transarticular screw fixation: results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves. American Association of Neurological Surgeons/Congress of Neurological Surgeons. J Neurosurg 88:634–640

    CAS  PubMed  Google Scholar 

  34. Zapletal J, de Valois JC (1997) Radiologic prevalence of advanced lateral C1–C2 osteoarthritis. Spine 22:2511–2513

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Schulthess Klinik, Spine Unit, Lengghalde 2, 8008, Zürich, Switzerland

    Dieter Grob, Friedrich H. Bremerich, Jiri Dvorak & Anne F. Mannion

  2. Department of Rheumatology and Institute of Physical Medicine, University Hospital Zürich, Zürich, Switzerland

    Anne F. Mannion

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  1. Dieter Grob
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  2. Friedrich H. Bremerich
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  3. Jiri Dvorak
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  4. Anne F. Mannion
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Correspondence to Anne F. Mannion.

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Grob, D., Bremerich, F.H., Dvorak, J. et al. Transarticular screw fixation for osteoarthritis of the atlanto axial segment. Eur Spine J 15, 283–291 (2006). https://doi.org/10.1007/s00586-005-0963-x

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  • DOI: https://doi.org/10.1007/s00586-005-0963-x

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