(Vergara P, Bal JS, Hickman Casey AT,
Crockard HA, Choi D. C1-C2 Posterior Fixation: Are Four Screws Better
Than Two? Neurosurgery. 2011 Nov 22)
Vergara et al. from London reported that Goel-Harms technique (segmental fixation of C1-C2 using 4 screws) is safer than Magerl technique. The authors evaluate the pros and cons of the most popular C1-C2 posterior fixation techniques: C1 lateral mass-C2 pedicle screw and rods (Goel-Harms) and transarticular screw (Magerl) fixations. The authors state that:
"METHODS: Retrospective review
of 122 patients who underwent Harms' or Magerl's fixation for
atlanto-axial instability. Surgical, clinical and radiological outcomes
were compared in the two groups.
RESULTS: 123 operations
were performed, of which 47 were by Harms' technique (Group-H) and 76
by Magerl's technique (Group-M). No significant differences were found
in duration of surgery, blood loss, post-operative pain and length of
hospitalization. Post-operatively, neck pain, C2-radiculopathy and hand
function improved in both groups, with better, but not statistically
significant, results for Group H. The intraoperative complication rate
was 2.1% in Group H and 21% in Group M (p<0.05); postoperative
complication rate was 10.6% in Group H and 21% in Group M
(p>0.05). The major complications were vertebral artery injury
(2.1% in Group H, 13.1% in Group M, p=0.05) and screw fracture (2.1% in
Group H, 9.2% in Group M, p>0.05). Fusion rate at the end of
follow-up was not-significantly higher in Group H. C1-C2 range of
movements in flexion/extension at the end of follow-up was lower in
Group H (p=0.017).
CONCLUSION: Magerl's
with posterior wiring and Harms' techniques are both effective options
for stabilizing the atlanto-axial complex. However, Harms' technique
appears to be safer, with fewer complications, and a more robust
long-term fixation."
Link for the abstract: http://www.ncbi.nlm.nih.gov/pubmed/22113242
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