Minimally Invasive Microscope-Assisted Stand-Alone Transarticular Screw Fixation without Gallie Supplementation in the Management of Mobile Atlantoaxial Instability
10.31616/asj.2018.12.4.710
- Author:
Tarun DUSAD
1
;
Vishal KUNDNANI
;
Shumayou DUTTA
;
Ankit PATEL
;
Gaurav MEHTA
;
Mahendra SINGH
Author Information
1. Department of Orthopaedics, Bombay Hospital & Medical Research Centre, Mumbai, India. tarundusad@gmail.com
- Publication Type:Original Article
- Keywords:
Atlanto-axial joint;
Joint instability;
Atlanto-axial fusion;
Minimal invasive;
Bone wire;
Allografts
- MeSH:
Allografts;
Asian Continental Ancestry Group;
Atlanto-Axial Joint;
Bone Wires;
Demography;
Female;
Follow-Up Studies;
Humans;
Joint Instability;
Male;
Neurology;
Retrospective Studies;
Transplants;
Vertebral Artery
- From:Asian Spine Journal
2018;12(4):710-719
- CountryRepublic of Korea
- Language:English
-
Abstract:
STUDY DESIGN: Retrospective study. PURPOSE: To evaluate the clinico-radiological efficacy of stand-alone minimally invasive transarticular screw (MIS-TAS) fixation without supplemental Gallie fixation in the management of mobile C1–C2 instability. OVERVIEW OF LITERATURE: Data evaluating the efficacy and feasibility of MIS-TAS in the literature is scanty. METHODS: Patients with mobile atlantoaxial instability and >2 years follow-up were included and managed by stand-alone TAS fixation using the Magerl technique and morselized allograft without additional fixation. Patient demographics and intra-operative parameters were noted. Clinical parameters (Visual Analog Scale [VAS] and Oswestry Disability Index [ODI]), neurology (modified Japanese Orthopaedic Association [mJOA]), and radiological factors (anterior atlanto-dens interval and space available for cord) were evaluated pre and postoperatively. Computed tomography (CT) was performed in patients who did not show interspinous fusion on X-ray at 1 year, to verify intra-articular fusion. Statistical analysis was performed using IBM SPSS ver. 20.0 (IBM Corp., Armonk, NY, USA); the Student t-test and analysis of variance were used to assess statistical significance (p <0.05). RESULTS: A total of 82 consecutive cases (three males, one female; mean age, 36.26±5.78 years) were evaluated. In total, 163 TASs were placed. Significant improvement was noticed in clinical (mean preoperative VAS=7.2±2.19, postoperative VAS=3.3±1.12; mean preoperative ODI=78.3±4.83, postoperative ODI=34.05±3.26) and neurological features (mean preoperative mJOA=14.73±2.68, postoperative mJOA=17.5±2.21). Radiological evidence of fusion was noted in 97.5% cases at final follow-up. Seventeen patients were found to have no interspinous fusions upon X-rays, but CT revealed facet fusion in all patients except in two. Inadvertent vertebral artery injury was noted in three cases. CONCLUSIONS: Stand-alone TAS fixation with morselized allograft provides excellent radiological and clinical outcomes. The addition of a supplementary tension band and structural graft are not essential. This provides the opportunity to avoid the complications associated with graft harvesting and wiring.
