C1-C2 stabilization by harms arthrodesis: Indications, technique, complications and outcomes in a prospective 26-case series - 12/03/14

Doi : 10.1016/j.otsr.2013.09.019

P. Bourdillon ^a, G. Perrin ^a,^⁎ , F. Lucas ^a, R. Debarge ^a, C. Barrey ^a,^b
^a Service de Neurochirurgie C et Chirurgie du Rachis, Hôpital Pierre-Wertheimer, GHE, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, 59, boulevard Pinel, 69500 Bron, France
^b Laboratoire de Biomécanique, Art et Métiers Paristech, ESNAM, 151, boulevard de l’Hôpital, 75013 Paris, France

^⁎Corresponding author.

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En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Wednesday 12 March 2014
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Abstract

Introduction

C1-C2 arthrodesis is a surgical challenge due to the proximity of neurovascular structures (vertebral arteries and spinal cord) and the wide range of motion of the joint, hampering bone fusion. A variety of techniques have been successively recommended to reduce anatomic risk and improve results in terms of biomechanical stability and fusion rates. Recently, Harms described a new technique using polyaxial screws in the C1 lateral masses and C2 pedicles.

Material and method

The present study reports our experience in a consecutive series of 26 patients operated on by C1-C2 arthrodesis using the Goel and Harms technique, and details technical aspects step by step. Routine systematic immediate postoperative CT and 6-month CT controlled screw positioning and assessed fusion. Follow-up was at least 1 year, except in 2 cases (10 months).

Results

Twenty-six patients with a mean age of 57 years were included. Indications comprised: C2 non-union (n=11), C1-C2 fracture and/or dislocation (n=11), inflammatory pathology (n=2) and tumoral pathology (n=2). The results showed the technique to be reliable (no neurovascular complications and 85% of screws with perfect positioning) and an excellent rate of fusion (100% at 6 months).

Conclusion

Anatomic and biomechanical considerations, combined with the present clinical and radiological outcomes, indicate that Goel and Harms fusion is to be considered the first-line attitude of choice for posterior C1-C2 arthrodesis.