European Spine Journal

, Volume 26, Issue 4, pp 1064–1072 | Cite as

Comparison of outcomes after atlantoaxial fusion with C1 lateral mass–C2 pedicle screws and C1–C2 transarticular screws

  • Panupol RajindaEmail author
  • Sirisomboon Towiwat
  • Piyawat Chirappapha
Original Article



To compare the clinical and radiological outcomes of posterior atlantoaxial fixation and fusion using C1 lateral mass–C2 pedicle screws (screw-rod constructs, SRC) with C1–C2 transarticular screws (TAS).


A retrospective review was conducted of 105 patients with atlantoaxial instability who underwent posterior C1–C2 fixation and fusion by SRC group (60 pt) and TAS group (45 pt). The follow-up period was minimum 2 years. Clinical outcomes measurements included the Numeric Rating Scale (NRS) for pain assessment, the Neck Disability Index (NDI), the Japanese Orthopedic Association (JOA) score and the American Spinal Injury Association (ASIA) impairment scale for the functional and neurological outcomes that were assessed. Radiological outcomes were assessed by evaluating the fusion rate and proper screws position. Both outcomes were evaluated in the early postoperative period, 3, 6, 12 and 24 months after surgery. Operative time, estimated blood loss, complications and length of stay were also reviewed.


The majority of cases were caused by trauma and presented with axial neck pain. The improvement of NRS, NDI, JOA score and ASIA impairment scale were not different between the two groups. Proper screw position and fusion rate were also observed similarly between the two groups. Estimated blood loss was lesser and operative time was shorter in TAS group than SRC group (p = 0.047, p = 0.001, respectively). Operative complications and the length of hospital stay were also not different between the two groups.


Both SRC and TAS produced excellent outcomes for atlantoaxial stabilization. But the volume of bleeding and operation time tended to be better in TAS group compared to SRC group.


Atlantoaxial instability Screw-rod constructs Transarticular screws Vertebral artery injury 


Compliance with ethical standards

Conflict of interest

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


  1. 1.
    Gallie WE (1939) Fractures and dislocation of the upper cervical spine. Am J Surg 46:495–499CrossRefGoogle Scholar
  2. 2.
    Brooks AL, Jenkins EB (1978) Atlantoaxial arthrodesis by the wedge compression method. J Bone Jt Surg Am 60(3):279–284CrossRefGoogle Scholar
  3. 3.
    Magerl F, Seemann P (1987) Stable posterior fusion of the atlas and axis by transarticular screw fixation. In: Kehr P, Weidner A (eds) Cervical spine I. Springer, New York, pp 322–327CrossRefGoogle Scholar
  4. 4.
    Hanson PB, Montesano PX, Sharkey NA, Rauschning W (1991) Anatomic and biomechanical assessment of transarticular screw fixation for atlantoaxial instability. Spine (Phila Pa 1976) 16(10):1141–1145CrossRefGoogle Scholar
  5. 5.
    Finn MA, Apfelbaum RI (2010) Atlantoaxial transarticular screw fixation: update on technique and outcome in 269 patients. Neurosurgery 66(suppl3):184–192CrossRefPubMedGoogle Scholar
  6. 6.
    Goel A, Laheri V (1994) Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir (Wein) 129:47–53CrossRefGoogle Scholar
  7. 7.
    Harms J, Melcher RP (2001) Posterior C1–C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976) 26:2467–2471CrossRefGoogle Scholar
  8. 8.
    Dickman CA, Sonntag VK (1998) Posterior C1–C2 transarticular screw fixation for atlantoaxial arthrodesis. Neurosurgery 43(2):275–280CrossRefPubMedGoogle Scholar
  9. 9.
    Xie Y, Li Z, Tang H (2009) Posterior C1 lateral mass and C2 pedicle. Screw internal fixation for atlantoaxial instability. J Clin Neurosci 16:1592–1594CrossRefPubMedGoogle Scholar
  10. 10.
    El Masry MA, El Assuity WI, Sadek FZ (2007) Two methods of atlantoaxial stabilisation for atlantoaxial instability. Acta Orthop Belg 73:741–746PubMedGoogle Scholar
  11. 11.
    Lee SH, Kim ES, Sung JK (2010) Clinical and radiological comparison of treatment of atlantoaxial instability by posterior C1–C2 transarticular screw fixation or C1 lateral mass–C2 pedicle screw fixation. J Clin Neurosci 17:886–892CrossRefPubMedGoogle Scholar
  12. 12.
    Coyne JJ, Fehlings MG, Wallace MC, Bernstein M, Tator CH (1995) C1–C2 posterior cervical fusion: long term evaluation of results and efficacy. Neurosurgery 37:688–692 (discussion 692–693) CrossRefPubMedGoogle Scholar
  13. 13.
    Farey ID, Nadkarni S, Smith N (1999) Modified Gallie technique versus transarticular screw fixation in C1–C2 fusion. Clin Orthop Relat Res 359:126–135CrossRefGoogle Scholar
  14. 14.
    Fraser AB, Sen C, Casden AM, Catalano PJ, Post KD (1994) Cervical transdural intramedullary migration of a sublaminar wire. A complication of cervical fixation. Spine (Phila Pa 1976) 19(4):456–459CrossRefGoogle Scholar
  15. 15.
    Xu T, Guo Q, Liu Q, Zhang P, Lu M, Lu X, Chen F, Guo X, Ni B (2016) Biomecanical evaluation of a novel integrated C1 laminar hook combined with C1–C2 transarticular screws for atlantoaxial fusion: an invitro human cadaveric study. World Neurosurg 92:133–139CrossRefPubMedGoogle Scholar
  16. 16.
    Aryan HE, Newman CB, Nottmeier EW (2008) Stabilization of the atlantoaxial complex via C–1 lateral mass and C–2 pedicle screw fixation in a multicenter clinical experience in 102 patients: modification of the Harms and Goel techniques. J Neurosurg Spine 8:222–229CrossRefPubMedGoogle Scholar
  17. 17.
    Fiore AJ, Haid RW, Rodts GE (2002) Alantal lateral mass screws for posterior spinal reconstruction technical note and case series. Neurosurg Focus 12:E5CrossRefPubMedGoogle Scholar
  18. 18.
    Stulik J, Vyskocil T, Sebesta P (2007) Atlantoaxial fixation using the polyaxial screw-rod system. Eur Spine J 16:479–484CrossRefPubMedGoogle Scholar
  19. 19.
    Yan L, He B, Liu T, Yang L, Hao D (2016) A prospective, double-blind, randomized controlled trial of treatment of atlantoaxial instability with C1 posterior arch >4 mm by comparing C1 pedicle with lateral mass screws fixation. BMC Musculoskelet Disord 17:164CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Kim JY, Oh CH, Yoon SH (2014) Comparison of outcomes after atlantoaxial fusion with transarticular screws and screw-rod constructs. J Korean Neurosurg 55(5):255–260CrossRefGoogle Scholar
  21. 21.
    Elliott RE, Tanweer O, Boah A, Morsi A, Ma T, Frempong-Boadu A (2014) Outcome comparison of atlantoaxial fusion with transarticular screws and screw-rod constructs: meta-analysis and review of literature. J Spinal Disord Technol 27(1):11–28CrossRefGoogle Scholar
  22. 22.
    Hott JS, Lynch JJ, Chamberlain RH (2005) Biomechanical comparison of C1–2 posterior fixation techniques. J Neurosurg Spine 2:175–181CrossRefPubMedGoogle Scholar
  23. 23.
    Resnick DK, Lapsiwala S, Trost GR (2002) Anatomic suitability of the C1–C2 complex for pedicle screw fixation. Spine (Phila Pa 1976) 27:1494–1498CrossRefGoogle Scholar
  24. 24.
    Sivaraju L, Mani S, Prabhu K, Daniel RT, Chacko AG (2016) Three-dimensional computed tomography angiographic study of the vertebral artery in patients with congenital craniovertebral junction anomalies. Eur Spine J. doi: 10.1007/s00586-016-4580-7 PubMedGoogle Scholar
  25. 25.
    Yoshida M, Neo M, Fujibayashi S et al (2006) Comparison of the anatomical risk for vertebral artery injury associated with the C2 pedicle screw and atlantoaxial transarticular screw. Spine (Phila Pa 1976) 31:E513–E517CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgerySunpasitthiprasong HospitalMuangThailand

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