[Dorsal atlantoaxial stabilization using the Goel-Harms technique]

[Dorsal stabilization of C1/C2 modified according to Goel-Harms with C1 pedicle screws]

OBJECTIVE

Stabilization of the atlantoaxial transition by an alternative screw position in C1.

INDICATIONS

Instabilities C1/C2 due to inflammation, tumor or trauma.

CONTRAINDICATIONS

Presence of a very small pedicle of C1. Variations in the course of the vertebral arteries.

SURGICAL TECHNIQUE

The midline approach to the upper cervical spine is used for the modified instrumentation of C1 with pedicle screws instead of Harms screws and for the unaltered instrumentation of C2. Depending on the indication, dorsal spondylodesis is performed by opening the laminae and attaching ceramic bone substitute material.

POSTOPERATIVE MANAGEMENT

In mobile patients, additional immobilisation with a soft collar is recommended for 6 weeks. Full recovery is given 3-4 months after surgery.

RESULTS

From January 2017 to September 2018, 21 stabilizations of the atlantoaxial transition were performed. The mean age was 72.52 ± 15.45 years. A total of 42 screws were placed in C1. In all, 21 (50%) C1 pedicle screwscould be placed, and in other 21 cases Harms screws were used. Complications were seen in 3 patients. Overall, considering the contraindications, the instrumentation of C1 with pedicle screws appears as a safe alternative to instrumentation with Harms screws.

[Injuries of the upper cervical spine : Update on diagnostics and management]

Injuries to the upper cervical spine represent a diagnostic and therapeutic challenge to the treating surgeon due to the complex anatomical relationships and biomechanical features. In this further education article the diagnostic principles, established classifications and therapeutic recommendations as well as injury-specific characteristics of bony and ligamentous injuries to the upper cervical spine (C0-C2) are presented.