• Bin Ni, Xiang Guo, Ning Xie, Xuhua Lu, Wen Yuan, Songkai Li, Fengjing Zhou, and Zhuangchen Zhu.
• Department of Orthopedics, The Second Affiliated Hospital, Second Military Medical University, Shanghai, People's Republic of China. nibin99@sohu.com
• Spine. 2010 Nov 15;35(24):E1367-72.

Study DesignAn atlantoaxial fixation using bilateral C1-C2 transarticular screws and C1 laminar hooks was used in 5 pediatric patients, who were then followed up for 12 to 17 months to evaluate the technique.ObjectiveTo describe a modified posterior C1-C2 fixation technique and preliminary clinical and radiographic results in 5 pediatric patients.Summary Of Background DataConventional posterior atlantoaxial fixations, such as Gallie and Brooks techniques, are frequently associated with high rates of pseudarthrosis and implant failure. The C1-C2 transarticular screw fixation has been shown to be effective in treatment of pediatric atlantoaxial instability, as well as adult atlantoaxial instability; however, this 2-point fixation merely stabilizes the atlantoaxial motion segment laterally. A 3-point fixation, composed with bilateral C1-C2 transarticular screws and C1 laminar hooks, has been developed.MethodsFive patients with atlantoaxial instability, including 4 males and 1 female, aged 6 to 17 (average 10) years, underwent atlantoaxial fixation using bilateral C1-C2 transarticular screws and C1 laminar hooks during a 2-year period. The surgical technique and treatment procedures were intensively reviewed, and clinical symptoms and imaging appearance were retrospectively evaluated.ResultsClinical follow-ups were obtained for an average of 14.4 (range: 12-17) months. The clinical and radiologic follow-up indicated a stable arthrodesis and offered clinical relief from symptoms for all patients. No neural or vascular impairment related to this technique was observed.ConclusionFixation of the atlantoaxial articulation using bilateral C1-C2 transarticular screws and C1 laminar hooks appears to be a reliable technique for treatment of pediatric atlantoaxial instability.

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