Mini-open approach combined with percutaneous transarticular screw fixation for C1-C2 fusion.

This paper describes a limited exposure for posterior C1-C2 arthrodesis aided by percutaneous transarticular fixation. The purpose of this study was to report the fusion rate using the aforementioned method. Fifty-seven patients (54 females and three males) with C1-C2 instability due to rheumatoid disease constituted the material of this study. The exposure was restricted to C0-C3 levels. The drilling and insertion of the screws was done through two mini stab wounds. A special sleeve and screwdriver were developed to facilitate this step. An autogenous iliac bone graft was fixed between the decorticated posterior arch of the atlas and the lamina of the axis vertebra. The mean of the atlantodental interval decreased from 8.5 mm (SD 2.3 mm) to 2.6 mm (SD 0.6 mm) at the immediate postoperative periods and reached 2.7 mm (SD 0.7 mm) after a mean follow-up of 30.4 months (SD 5.6 months). Malposition of the screws was observed in two patients and warranted a second operation in one. Fusion was evident in 98% of the cases. Percutaneous insertion of the screws in posterior C1-C2 transarticular fixation reduces the size of the exposure and the surgical trauma to the cervical segments below the fixation.