Journal List > J Korean Orthop Assoc > v.27(1) > 1114430

Moon, Ok, Lee, Ha, Kim, Sun, Kim, Shin, and Kim: Posterior Stabilization Surgery for Atlantoaxial Instability by Wiring

Abstract

Congenital anomalies, various dease states, and trauma can adversely affect the stability of the upper cervical spine. Once its instability and the cause have been found, the stability should be provided to protect the cervical cord and vertebral arteries by any means. Many procedures have been recommended for stabilization, such as wires or fascial loops, with or without interposed bone graft. In most cases fixation is restricted to Cl-C2 segment, though other authors included the occiput or the segment C3. In this series only dorsal arthrodesis was done. Twenty-seven cases having the atlantoaxial instability were treated by posterior wiring and stabilization fusion, among which 22 cases were odontoid fractures, one rotatory subluxation and 4 odontoid anomalies. The youngest was a 3 year-old boy, and oldest, 35 year-old lady. A no. 18 or no. 20 wire loop was used for the stabilization. Later two doubled no. 20 stainless steel wires were used to prevent the wire breakage and to provide the more secure stabilization. Cl-C2 fixation was done in all cases except one in which case C3 was included. Postoperatively their necks were immobilized by head halter for 6-8 weeks in beds, and then were placed in a cervicothoracic orthosis. Immobilization was continued for 12 weeks. Fusion time was ranged from 14 to 18 weeks, with an average of 15 weeks. Failure of fusion developed in 3 patients (11.5%), and wire breakage in 4 (15.4%) patients, but fractures of the spinous processes or vertebral arches were not encountered. Wire breakage was due to the use of a single or fine wire loops, and inadequate posteop immobilization. Wire breakage was combined with fusion failure in two cases. In a cases of congenital anomaly of the dens, fusion failure developed with recurrent instability. In all cases the results were satifactory even in case with fusion failure. Through this study it was reconfirmed that fusion failure is high in cases of instability related to anomalies of the odontoid process and inadequate wire immobilzation, and also that the Brooks fusion is the simplest and effective one in the clinical trial.

TOOLS
Similar articles