[Application of atlas pedicle screw system fixation and fusion for treatment of upper cervical disease].

Objective: To explore the feasibilities, methods, outcomes and indications of atlas pedicle screw system fixation and fusion for the treatment of upper cervical diseases.

Methods: From October 2004 to January 2006, 17 patients with upper cervical diseases were treated with atlas pedicle screw system fixation and fusion. There were 13 males and 4 females, ageing 19 to 52 years. Of 17 cases, there were 14 cases of atlantoaxial dislocation (including 3 cases of congenital odontoid disconnection,4 cases of old odontoid fracture, 2 cases of new odontoid fracture (type II C), 3 cases of rupture of the transverse ligament, and 2 cases of atlas fracture; 2 cases of tumor of C2; 1 case of giant neurilemoma of C2.3 with instability after the resection of tumors. JOA score before operation was 8.3+/-3.0.

Results: The mean operative time and bleeding amount were 2.7 hours (2.1-3.4 hours) and 490 ml (300-750 ml) respectively. No injuries to the vertebral artery and spinal cord were observed. The medial-superior cortex of lateral mass was penetrated by 1 C1 screw approximately 3 mm without affecting occipito-atlantal motions. All patients were followed up 3-18 months. The clinical symptoms were improved in some extents and the screws were verified to be in a proper position, no breakage or loosening of screw and rob occurred. All patients achieved a solid bone fusion after 3-6 months. JOA score 3 months after operation was 14.6+/-2.2. JOA improvement rates were 73%-91% (mean 82%).

Conclusion: The atlas pedicle screw system fixation and fusion is feasible for the treatment of upper cervical diseases and has better outcomes, wider indications if conducted properly.