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Updated: Jul 3, 2026
C-arm-Free Simultaneous OLIF51 and Percutaneous Pedicle Screw Fixation in a Single Lateral Position
Published on: September 16, 2022
Restoring stability at the craniovertebral junction using the Goel technique: Outcomes of posterior C1-C2 fixation in
Jignesh Joshi1, Srikant Balasubramaniam1, Banumathy Srikant1
1Department of Neurosurgery, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India.
Background:
Atlantoaxial instability arising from diverse craniovertebral junction (CVJ) pathologies poses substantial surgical challenges because of complex regional biomechanics and proximity to critical neurovascular structures. Posterior C1-C2 fixation using the Goel-Harms technique is widely adopted; however, large institutional outcome data remain limited.
Objective:
The objective of this study was to evaluate the clinical and radiological outcomes, perioperative parameters, and complications following posterior C1-C2 fixation in patients with CVJ anomalies and atlantoaxial instability.
Materials And Methods:
A retrospective cohort study was performed of patients who underwent posterior C1 lateral mass-C2 pedicle screw fixation between January 2008 and December 2023 at a single tertiary center. Clinical outcomes were assessed using the Visual Analog Scale (VAS), Nurick grading system, and Oswestry Disability Index (ODI). Radiological evaluation included the atlantodental interval (ADI), clivus-canal angle, and standard craniometric lines. Perioperative variables, complications, and length of hospital stay were analyzed.
Results:
A total of 216 patients were included (mean age: 34.6 ± 5.2 years; 62.0% male). Traumatic pathology was the most common etiology (45.4%), followed by congenital (24.1%) and degenerative causes (16.7%). Significant postoperative improvement was observed in VAS (5.39 ± 1.68-1.46 ± 1.21), Nurick grade (3.68 ± 1.26-2.06 ± 0.87), and ODI (49.4 ± 12.2-22.19 ± 9.3) (all P < 0.001). Radiological parameters demonstrated significant correction, including ADI and clivus-canal angle (P < 0.001). The overall mortality rate was 1.39%. The mean intensive care unit stay was 2.3 ± 1.4 days, and the mean hospital stay was 8.5 ± 3.3 days.
Conclusion:
Posterior C1-C2 fixation using the Goel-Harms technique provides safe, reproducible, and effective stabilization, with significant clinical and radiological improvement in patients with atlantoaxial instability associated with CVJ anomalies.
