Atlantoaxial fusion with transarticular screws: meta-analysis and review of the literature

World Neurosurg. 2013 Nov;80(5):627-41. doi: 10.1016/j.wneu.2012.03.012. Epub 2012 Mar 31.

Abstract

Objective: To review published series describing C1-2 posterior instrumented fusions and summarize clinical and radiographic outcomes of patients treated with transarticular screw (TAS) fixation.

Methods: Online databases were searched for English-language articles published between 1986 and April 2011 describing posterior atlantoaxial instrumentation with C1-2 TAS fixation. There were 45 studies including 2073 patients treated with TAS that fulfilled inclusion criteria. Meta-analysis techniques were used to calculate outcomes.

Results: All studies provided class III evidence. The 30-day perioperative mortality rate was 0.8%, and the incidence of neurologic injury was 0.2%. The incidence of clinically significant malpositioned screws was 7.1% (confidence interval [CI], 5.7%-8.8%), the incidence of vertebral artery injury was 3.1% (CI, 2.3%-4.3%), and the rate of fusion with the TAS technique was 94.6% (CI, 92.6%-96.1%).

Conclusions: TAS fixation is a safe and effective treatment option for C1-2 instability with high rates of fusion (approximately 95%). Screw malposition and vertebral artery injury occurred in approximately 5% of patients. The successful insertion of TAS requires a thorough knowledge of atlantoaxial anatomy.

Keywords: AANS/CNS; American Association of Neurological Surgeons/Congress of Neurological Surgeons; Arthrodesis; Atlantoaxial; C1-2; C1-C2; CI; Confidence interval; TAS; Transarticular screw; VAI; Vertebral artery; Vertebral artery injury.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Atlanto-Axial Joint / surgery*
  • Bone Screws*
  • Humans
  • Joint Instability / mortality
  • Joint Instability / surgery*
  • Spinal Fusion / instrumentation*
  • Spinal Fusion / methods*
  • Spinal Fusion / mortality
  • Vertebral Artery / surgery