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Subaxial sagittal alignment after atlantoaxial fixation techniques.
Shigeki Oshima1, Hideki Sudo, Manabu Ito
1*Hokkaido Orthopaedic Memorial Hospital †Department of Advanced Medicine for Spine and Spinal Cord Disorders, Hokkaido University Graduate School of Medicine ‡Sapporo Orthopaedic Hospital, Sapporo, Hokkaido, Japan.
Journal of Spinal Disorders & Techniques
|August 6, 2014
Summary
Increased C1-C2 lordosis after atlantoaxial instability surgery correlates with C2-C7 kyphosis. Careful C1-C2 fixation angle selection is crucial to prevent subaxial kyphotic changes.
Area of Science:
- Spine surgery
- Orthopedics
- Neurosurgery
Background:
- Atlantoaxial instability is treated with posterior fusion techniques like Magerl wiring or C1 lateral mass screw (C1-LMS) with C2 pedicle screw fixation.
- Limited research exists on the relationship between postoperative C1-C2 angle and C2-C7 sagittal alignment post-C1-C2 fixation.
Purpose of the Study:
- To evaluate the association between the C1-C2 fixation angle and postoperative C2-C7 alignment in the sagittal plane.
- To compare outcomes between C1-LMS and Magerl with wiring techniques for atlantoaxial instability.
Main Methods:
- A retrospective case series of 42 patients with C1-C2 instability treated with C1-LMS (22 patients) or Magerl with wiring (20 patients).
- Follow-up exceeded 2 years, measuring atlantodental interval, spinal cord space, and various cervical angles (O-C1, C1-C2, C2-C3, C2-C7).
Main Results:
- Both techniques significantly reduced the atlantodental interval and increased spinal cord space.
- The C1-C2 angle at final follow-up was higher in the Magerl with wiring group compared to the C1-LMS group (P<0.01).
- A negative correlation was found between the C1-C2 fixation angle and postoperative C2-C7 angle in both groups (r=-0.55 to -0.62, P<0.01).
Conclusions:
- Increased lordotic changes in the C1-C2 angle are associated with increased kyphotic changes in the C2-C7 angle following both surgical procedures.
- The C1-LMS technique demonstrated effective control of C1-C2 sagittal alignment during surgery.
- Careful determination of the C1-C2 fixation angle is recommended to minimize the risk of postoperative subaxial kyphotic deformity.
