Evaluation of Fixation of Atlantoaxial Subluxation Using Harms' Te

Abstract

he placement of C1 lateral mass, C2 pedicle screw screws provide a useful alternative method to achieve atlantoaxial fixation. This method achieves immediate rigid stabilization of the atlantoaxial joint and obviates the need for halo vest immobilization. This technique may be used in certain cases as an alternative to occipitocervical fusion, and may also be used to increase construct stability when occipitocervical fixation is used. Evaluation of the course of the vertebral artery with preoperative CT scanning and use of intraoperative fluoroscopy or image guidance are mandatory when using this technique. Placement of C2 screw is a technically demanding procedure that may result in grave complications from vertebral artery injury if improperly performed. We thus advocate that this procedure only be performed by surgeons who are highly experienced in the treatment of atlantoaxial instability, and who have an intimate understanding of the anatomy of this region. Further biomechanical analysis of this technique should be performed to quantify the strength of constructs employing C1 lateral mass, C2 pedicle screws as compared with other fixation methods.