C1-C2 transarticular screw fixation for treatment of C1-C2 instability

C1-C2 instability has traditionally been treated by C1-C2 posterior wiring and bone grafting. However, this technique has an incidence of non-union which may exceed 10%. Transarticular screw fixation has developed as a technique of providing increased strength of fixation of C1-C2 arthrodesis, while at the same time avoiding the need for postoperative halo bracing and avoiding the risk of neurological injury associated with the passage of sublaminar wires. We present a retrospective review of 12 patients with C1-C2 instability treated by C1-C2 transarticular screw fixation. Eight patients underwent this procedure as primary treatment, and 4 after a failed Gallie fusion. Five patients had a cruciate ligament rupture, 5 had an odontoid process fracture, 1 had os odontoideum, and 1 had rheumatoid instability. There was no surgical morbidity or mortality and, at a mean follow up of 12.1 +/- 3 months (range 8-14 months), all patients had achieved solid fusion, and all neurological symptoms referable to the instability had resolved. C1-C2 transarticular screw fixation has been shown to be safe and effective and has a number of advantages when compared to traditional posterior wiring techniques. We recommend that this technique be considered as a primary treatment of C1-C2 instability.