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Surgical Approach and Complications of Stand-alone Lateral Trans-Psoas Interbody Fusion

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Risk Factors for Radiologic Subaxial Cervical Pathology After C1-2 Posterior Fusion.

Chungwon Bang¹, Kee-Won Rhyu¹, Young-Yul Kim¹

¹Department of Orthopedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03083, Republic of Korea.

Journal of Clinical Medicine

|March 14, 2026

Summary

Rheumatoid arthritis (RA) and C1-7 sagittal vertical axis (SVA) are key risk factors for subaxial degenerative changes after atlantoaxial posterior fusion. These findings aid in predicting and managing post-surgical complications.

Keywords:

C1-2 fusion rheumatoid arthritis subaxial cervical spine

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Last Updated: May 12, 2026

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Area of Science:

Spine surgery
Orthopedics
Radiology

Background:

Atlantoaxial posterior fusion is common, but adjacent segment degeneration is a concern.
Unique post-fusion findings may occur due to the procedure's characteristics.

Purpose of the Study:

To identify risk factors for subaxial degenerative changes after atlantoaxial posterior fusion.
To analyze radiologic and clinical factors associated with post-fusion pathology.

Main Methods:

Retrospective analysis of 58 patients undergoing atlantoaxial posterior fusion.
Radiographic assessment including neutral, flexion, and extension lateral views.
Classification into radiologic subaxial pathology (RSP) and non-RSP groups based on spinal instability or arthritic changes.

Main Results:

Rheumatoid arthritis (RA) and a lower 3-month C1-7 sagittal vertical axis (SVA) were significantly associated with RSP.
Multivariate analysis identified RA and 3-month C1-7 SVA as independent risk factors for RSP.
A positive correlation was found between 3-month C1-7 SVA and the C1-2 Cobb angle.

Conclusions:

Rheumatoid arthritis (RA) and C1-7 SVA are significant risk factors for radiologic subaxial pathology (RSP) after atlantoaxial posterior fusion.
Early C1-7 SVA measurement is crucial for predicting RSP.
Findings aid in risk stratification and management of patients undergoing this procedure.