DORSAL PERCUTANOUS FIXATION OF C1/2 IN C1 AND C2 FRACTURES OF OLD PATIENTS

Abstract

Goals: Advantage of the dorsal fixation of C1/2

Materials and Methods: From 01/2006 to 12/2006 22 patients with a traumatic fracture of C1/2 were operativly stabilized. The avarage age was 79 year (66–92). No neurological deficit. Diagnostic was always a CT-scan for classification of fracture typ. 7 patients were temporarily immobilized with HALO fixateur. Within th next 8 days final operation hab been carried out. 7 patients with Anderson fractures typ II were stabilized with open fixation from ventral (group 1). 4 Jefferson fractures and 2 combined C1/2 fractures were were stabilized with open fixation from dorsal (Magerl) (group 2). Percutanous fixation from dorsal was done in 5 patients with fractures of the atlas, 4 with Anderson fractures typ II (group3). Clinical and radiological follow up was done in 18 patients

Results: Duration for operation was in 64min in group1, 134min in group 2 and in 42min in group3. No neurological deficit or damage of A.vertebralis occurred. Blood loss was in group 1 and 3 under 50ml in group 2 750ml. In group3 one slightly dislocation of screw happened without need of revision. Movement of cervical spine was reduced in group 2 and 3. During follow up 3 of seven ventral stabilized Anderson fractures typ II (group1) were dislocated. Dorsal percutanous fixation for operatively revision was done.

Discussion: Percutanous dorsal transarticular screw fixation C1/2 is a challanging procedure for stabilization of atlantoaxial fractures. Main advantages compared to other operation techniques are less blood loss, short operation time, high rate of success.