C1-C2 stabilization by harms arthrodesis: Indications, technique, complications and outcomes in a prospective 26-case series - 22/03/14
, F. Lucas a, R. Debarge a, C. Barrey a, b
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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.
Level of Evidence |
Level IV prospective study.
El texto completo de este artículo está disponible en PDF.Keywords : Harms, C1-C2 fusion, Cervical fusion, C1-C2 instability, C1-C2 screws, Cervical spine arthrodesis
Esquema
Vol 100 - N° 2
P. 225-231 - avril 2014 Regresar al número
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