Comparison between C1–2 Fixation with and without Supplemental Posterior Wiring

摘要

>Study Design Retrospective analysis. >Clinical Question Is there a difference between the screw–rod construct (SRC) procedure without wiring and the SRC procedure with wiring with respect to fusion, implant failure, reoperation, donor-site morbidity, and complication rates? >Patients and Methods We performed a retrospective analysis of 26 patients who underwent C1–2 fixation between 2004 and 2012 (SRC with wiring and structural bone graft, 13 patients; SRC with autograft but without wiring, 13 patients). Fusion was assessed using dynamic X-rays in all patients and computed tomographic scans in selected cases. Pseudoarthrosis was confirmed during reoperation. >Results The mean follow-up time was 2 years and 5 months for the SRC without wiring group and 2 years and 1 month for the SRC with wiring group. Patients with less than 1-year follow-up time were excluded. The fusion rate, implant failure rate, and reoperation rates for the SRC without wiring group were 92, 8, and 8%, respectively. The fusion, implant failure, and reoperation rates for the SRC with wiring group were 100, 0, and 0%, respectively. There were no donor-site morbidities or complications in either group (both 0%). There were no differences in parameters we examined between the two groups (p > 0.05 for each rate, Fisher exact test). >Conclusions The results suggest that supplementing the SRC procedure with wiring may increase fusion rate, but this difference is not statistically significant. Although the sample size was small, there was not a significant discrepancy in outcomes between the two groups at an average follow-up of 2 years. rules="all" class="rendered small default_table">>Final class of evidence (CoE)—treatmentYes> align="left" valign="top" rowspan="1" colspan="1">Study Design align="left" valign="top" rowspan="1" colspan="1">> align="left" valign="top" rowspan="1" colspan="1"> RCT align="left" valign="top" rowspan="1" colspan="1">> align="left" valign="top" rowspan="1" colspan="1"> Cohort align="left" valign="top" rowspan="1" colspan="1">X> align="left" valign="top" rowspan="1" colspan="1"> Case-control align="left" valign="top" rowspan="1" colspan="1">> align="left" valign="top" rowspan="1" colspan="1"> Case series align="left" valign="top" rowspan="1" colspan="1">> align="left" valign="top" rowspan="1" colspan="1">Methods align="center" valign="top" rowspan="1" colspan="1">> align="left" valign="top" rowspan="1" colspan="1"> Concealed allocation (RCT) align="center" valign="top" rowspan="1" colspan="1">> align="left" valign="top" rowspan="1" colspan="1"> Intention to treat (RCT) align="center" valign="top" rowspan="1" colspan="1">> align="left" valign="top" rowspan="1" colspan="1"> Blinded/independent evaluation of primary outcome align="center" valign="top" rowspan="1" colspan="1">> align="left" valign="top" rowspan="1" colspan="1"> F/U ≥ 85% align="left" valign="top" rowspan="1" colspan="1">> align="left" valign="top" rowspan="1" colspan="1"> Adequate sample size align="center" valign="top" rowspan="1" colspan="1">> align="left" valign="top" rowspan="1" colspan="1"> Control for confounding align="center" valign="top" rowspan="1" colspan="1">> align="left" valign="top" rowspan="1" colspan="1">Overall class of evidence align="center" valign="top" rowspan="1" colspan="1">III class="kwd-title">Keywords: SRC, posterior wiring, Harms technique, atlantoaxial instability, C1, C2, fusion, screw rod construct class="head no_bottom_margin" id="__sec1title">Study Rationale and ContextWhen treating atlantoaxial stability, the posterior C1 lateral mass screw and C2 pars or pedicle screw construct (screw–rod construct [SRC]) with onlay autograft have yielded high-fusion rates. Some surgeons supplement the SRC procedure with posterior wiring using structural bone graft (Brooks, Gallie, Sonntag), which increases operative time and expense.