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Original ArticleOpen Access
Posterior ClC2 Transarticular Screw Fixation for Atlanto-Axial Instability
Panjaisee S 
The objective of this study was to reveal that the treatment of C l-C2 instability by trans-
articular C l-C2 screw fixation with bone graft has a better result than conventional sublaminar
wiring with bone graft by GaBie's technique. This technique, proposed by Mager! and Semann in
1987, produces a rigid three points fixation resulting in maximal bone fusion rate and does not
require an orthosis post-operatively. This technique is performed in patients with fractured
lamina of Cl or in patients who need a laminectomy of Cl for spinal cord decompression. This
study revealed 10 patients having Cl-C2 instability who were operated on by transarticular Cl-C2
screw fixation with bone graft. No complication was encountered. No screw and bone graft
slipping were noted. The patients were improved clinically and the average follow-up period was
7.7 months. There were 2 cases which had previously been operated on for sublaminar wiring but
the operation was unsuccessful because there was a fractured lamina of Cl. Both patients were
sent to Prasat Neurological Institute
&
Hospital for transarticular Cl-C2 screw fixation. Another
2 cases were operated on for sublaminar wiring with bone graft. The follow-up X-ray of both
cases disclosed a displacement of C l-C2. Lost of C 1 lamina was found in one case and there was
slipping of wire in another case, because of this the patients were re-explored for transarticular
Cl-C2 screw fixation with bone graft. The conclusion is, this technique of transarticular Cl-C2
screw fixation, is the best surgical treatment for Cl-C2 instability, in the hands of experienced
surgeons with an excellent knowledge of anatomy.
Key word : Sublaminar Wiring, Rigid Three Points Fixation, Transarticular Screw Fixation, Bone
Graft
articular C l-C2 screw fixation with bone graft has a better result than conventional sublaminar
wiring with bone graft by GaBie's technique. This technique, proposed by Mager! and Semann in
1987, produces a rigid three points fixation resulting in maximal bone fusion rate and does not
require an orthosis post-operatively. This technique is performed in patients with fractured
lamina of Cl or in patients who need a laminectomy of Cl for spinal cord decompression. This
study revealed 10 patients having Cl-C2 instability who were operated on by transarticular Cl-C2
screw fixation with bone graft. No complication was encountered. No screw and bone graft
slipping were noted. The patients were improved clinically and the average follow-up period was
7.7 months. There were 2 cases which had previously been operated on for sublaminar wiring but
the operation was unsuccessful because there was a fractured lamina of Cl. Both patients were
sent to Prasat Neurological Institute
&
Hospital for transarticular Cl-C2 screw fixation. Another
2 cases were operated on for sublaminar wiring with bone graft. The follow-up X-ray of both
cases disclosed a displacement of C l-C2. Lost of C 1 lamina was found in one case and there was
slipping of wire in another case, because of this the patients were re-explored for transarticular
Cl-C2 screw fixation with bone graft. The conclusion is, this technique of transarticular Cl-C2
screw fixation, is the best surgical treatment for Cl-C2 instability, in the hands of experienced
surgeons with an excellent knowledge of anatomy.
Key word : Sublaminar Wiring, Rigid Three Points Fixation, Transarticular Screw Fixation, Bone
Graft
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