Prospective, Self-controlled, Comparative Study of Transposterior Arch Lateral Mass Screw Fixation and Lateral Mass Screw Fixation of the Atlas in the Treatment of Atlantoaxial Instability

STUDY DESIGN: A prospective self-controlled study. OBJECTIVE: The aim of the present study was to compare the application and clinical outcomes of transposterior arch lateral mass screw and lateral mass screw fixation of the atlas in the treatment of atlantoaxial instability. SUMMARY OF BACKGROUND DATA: Atlas posterior screw fixation techniques comprise transposterior arch lateral mass screw fixation and lateral mass screw fixation. Previous studies have focused mainly on the feasibility of the anatomy and the biomechanics of the methods. METHODS: From June 2006 to February 2011, 66 patients with atlantoaxial instability were randomly assigned for treatment with transposterior arch lateral mass screw or lateral mass screw fixation of the atlas, combined with axis pedicle screw fixation. Patients were followed up regularly. The operation time, blood loss, intraoperative complications, Japan Department of Orthopedics Association Score, visual analog scale score, and bone fusion rates were recorded. RESULTS: The operation was successful in all 66 cases, with all patients showing improvement in clinical symptoms. There were significant differences in operation time and blood loss between the 2 groups (P<0.001). The mean follow-up time was 49 months. At the final follow-up, the Japan Department of Orthopedics Association score was significantly better than the preoperative score (mean, 13.5; P<0.05). The mean postoperative improvement rate was 88.2% and the mean visual analog scale score was 1.9; both results were significant as compared with preoperative results (P<0.05). Bone fusion was achieved within 6 months after operation. No screw loosening, shifting, breakage, or atlantoaxial instability was observed. Six patients with atlas lateral mass screw placement had burst bleeding of C1-C2 venous plexus during surgery. Five patients had immediate pain and numbness at the occipitocervical region. CONCLUSIONS: Atlas transposterior arch lateral mass screw fixation is less invasive, simple, has fewer complications, and offers good fixation results for atlantoaxial instability as compared with lateral mass screw fixation.