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Clinical Results of Harms Technique in Atlantoaxial Instability Treatment

Year 2020, Volume: 6 Issue: 3, 294 - 298, 31.12.2020
https://doi.org/10.19127/mbsjohs.771475

Abstract

Objective: The aim of this study is to present the clinical experience and results in the application of atlantoaxial stabilization performed with Harms technique to contribute to the literature.
Methods: Archive files of adult patients who underwent C1-2 stabilization using Harms technique with the diagnosis of atlantoaxial instability for 2015-2020 were examined. Clinical and radiological findings of 15 patients with at least 6 months of follow-up were evaluated. Preoperative clinical and radiological records, preoperative observations, postoperative complications, and clinical responses were evaluated.
Results: 15 patients included in the study; 10 were men and 5 were women. The age range was 25-82 (mean: 58.7). There were 6 patients (40.0%) who had Anderson and D'Alanzo classification type 2 odontoid fracture 2 patients (13.3%) with Jefferson fracture, 2 patients (13.3%) with C2 extension type tear drop fracture, 2 patients (13.3%) with narrowing in the level of craniocervical junction, 1 patient (6.7%) with upper cervical region tumor and 2 patients (13.3%) was in the form of hangmans fracture. Screw malposition was not observed in the postoperative period. Bone fusion developed in all patients after surgery. No vertebral artery damage or neurological damage was observed. Wound infection was not observed in any of these patients. Visual analog scale (VAS) reduction and Japanese orthopedic (JOA) scores were increased in all postoperative patients.
Conclusion: Surgery of atlantoaxial instability is a pathology requiring adequate surgical experience due to the complicated anatomical structure. Using the Harms technique, sufficient stability is provided with a low complication rate. With this method, improvement in the clinical findings of the patients and high bone fusion were obtained.

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References

  • Anderson LD, D’ Alanzo R. Fractures of the odontoid proces of the axis. J Bone joint Surg Am 1974; 56: 1663-74.
  • Badhiwala JH, Nassiri F, Witiw CD, Mansouri A, Almenawer SA, Fehlings MG. Does Transection of the C2 Nerve Roots During C1 Lateral Mass Screw Placement for Atlantoaxial Fixation Result in a Superior Outcome? A Systematic Review of the Literature and Meta-analysis. Spine 2017; 42: E1067-76.
  • Brooks AL, Jenkins EB. Atlanto-axial arthrodesis by the wedge compression method. J Bone Joint Surg Am 60(3):279-284, 1978
  • Chen Q, Brahimaj BC, Khanna R, Kerolus MG, Tan LA, David B,et al. Posterior atlantoaxial fusion: a comprehensive review of surgical techniques and relevant vascular anomalies. J Spine Surg 2020; 6(1):164-180.
  • Coyne TJ, Fehlings MG, Wallace MC, Bernstein M, Tator CH. C1-C2 posterior cervical fusion: long-term evaluation of results and efficacy. Neurosurgery. 1995;37(4):688-693.
  • Caglar S. Aydin Z. Tuna H. Upper Cervical Region Traumas. in Aksoy K. (ed.) Basic Neurosurgery vol 2. Turkish Neurosurgery Association, Ankara, 2005, 1164-1173.
  • Dagtekin A, Kara E, Vayisoglu Y, Koseoglu A, Avci E, Talas D, et al. The importance of early diagnosis and appropriate treatment in Grisel's syndrome: report of two cases. Turk Neurosurg. 2011; 21(4):680-684.
  • Dickman CA, Sonntag VK. Posterior C1-C2 transarticular screw fixation for atlantoaxial arthrodesis. Neurosurgery. 1998;43(2):275-281.
  • Dobran M, Nasi D, Esposito DP, Iacoangeli M. Posterior Fixation with C1 Lateral Mass Screws and C2 Pars Screws for Type II Odontoid Fracture in the Elderly: Long-Term Follow-Up. World Neurosurg. 2016;96:152-158.
  • Gallie WE. Fractures and dislocations of the cervical spine. Am J Surg 1939; 46:495-499.
  • Goel A, Laheri V. Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir (Wien). 1994;129(1-2):47-53.
  • Harms J, Melcher RP. Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976). 2001;26(22):2467-2471.
  • Holness RO, Huestis WS, Howes WJ, Langille RA. Posterior stabilization with an interlaminar clamp in cervical injuries: technical note and review of the long-term experience with the method. Neurosurgery. 1984;14(3):318-322.
  • Huang DG, Hao DJ, He BR, Wu QN, Liu TJ, Wang XD, et al. Posterior atlantoaxial fixation: a review of all techniques. Spine J. 2015;15(10):2271-2281.
  • Kim DH, Hilibrand AS: Rheumatoid arthritis in the cervical spine. J Am Acad Orthop Surg 2005, 13(7):463-474.
  • Low HL, Redfern RM. C1-C2 transarticular screw fixation for atlantoaxial instability: a 6-year experience, and C1-C2 transarticular screw fixation-technical aspects. Neurosurgery. 2002;50(5):1165-1166.
  • Magerl F, Seemann PS. Stable posterior fusionof the atlas and axis by transarticular screw fixation. In: Kehr P, Weidner A (eds). Cervical Spine 1. New York: Springer-Verlag, 1987:322- 327.
  • Isik HS, Sandal E, Cagli S. Clinical Outcomes of Posterior C1 and C2 Screw-Rod Fixation for Atlantoaxial Instability. Turk Neurosurg 2018; 28(4):602-609.
  • Rajinda P, Towiwat S, Chirappapha P. Comparison of outcomes after atlantoaxial fusion with C1 lateral mass-C2 pedicle screws and C1-C2 transarticular screws. Eur Spine J. 2017;26(4):1064-1072.
Year 2020, Volume: 6 Issue: 3, 294 - 298, 31.12.2020
https://doi.org/10.19127/mbsjohs.771475

Abstract

Project Number

no

References

  • Anderson LD, D’ Alanzo R. Fractures of the odontoid proces of the axis. J Bone joint Surg Am 1974; 56: 1663-74.
  • Badhiwala JH, Nassiri F, Witiw CD, Mansouri A, Almenawer SA, Fehlings MG. Does Transection of the C2 Nerve Roots During C1 Lateral Mass Screw Placement for Atlantoaxial Fixation Result in a Superior Outcome? A Systematic Review of the Literature and Meta-analysis. Spine 2017; 42: E1067-76.
  • Brooks AL, Jenkins EB. Atlanto-axial arthrodesis by the wedge compression method. J Bone Joint Surg Am 60(3):279-284, 1978
  • Chen Q, Brahimaj BC, Khanna R, Kerolus MG, Tan LA, David B,et al. Posterior atlantoaxial fusion: a comprehensive review of surgical techniques and relevant vascular anomalies. J Spine Surg 2020; 6(1):164-180.
  • Coyne TJ, Fehlings MG, Wallace MC, Bernstein M, Tator CH. C1-C2 posterior cervical fusion: long-term evaluation of results and efficacy. Neurosurgery. 1995;37(4):688-693.
  • Caglar S. Aydin Z. Tuna H. Upper Cervical Region Traumas. in Aksoy K. (ed.) Basic Neurosurgery vol 2. Turkish Neurosurgery Association, Ankara, 2005, 1164-1173.
  • Dagtekin A, Kara E, Vayisoglu Y, Koseoglu A, Avci E, Talas D, et al. The importance of early diagnosis and appropriate treatment in Grisel's syndrome: report of two cases. Turk Neurosurg. 2011; 21(4):680-684.
  • Dickman CA, Sonntag VK. Posterior C1-C2 transarticular screw fixation for atlantoaxial arthrodesis. Neurosurgery. 1998;43(2):275-281.
  • Dobran M, Nasi D, Esposito DP, Iacoangeli M. Posterior Fixation with C1 Lateral Mass Screws and C2 Pars Screws for Type II Odontoid Fracture in the Elderly: Long-Term Follow-Up. World Neurosurg. 2016;96:152-158.
  • Gallie WE. Fractures and dislocations of the cervical spine. Am J Surg 1939; 46:495-499.
  • Goel A, Laheri V. Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir (Wien). 1994;129(1-2):47-53.
  • Harms J, Melcher RP. Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976). 2001;26(22):2467-2471.
  • Holness RO, Huestis WS, Howes WJ, Langille RA. Posterior stabilization with an interlaminar clamp in cervical injuries: technical note and review of the long-term experience with the method. Neurosurgery. 1984;14(3):318-322.
  • Huang DG, Hao DJ, He BR, Wu QN, Liu TJ, Wang XD, et al. Posterior atlantoaxial fixation: a review of all techniques. Spine J. 2015;15(10):2271-2281.
  • Kim DH, Hilibrand AS: Rheumatoid arthritis in the cervical spine. J Am Acad Orthop Surg 2005, 13(7):463-474.
  • Low HL, Redfern RM. C1-C2 transarticular screw fixation for atlantoaxial instability: a 6-year experience, and C1-C2 transarticular screw fixation-technical aspects. Neurosurgery. 2002;50(5):1165-1166.
  • Magerl F, Seemann PS. Stable posterior fusionof the atlas and axis by transarticular screw fixation. In: Kehr P, Weidner A (eds). Cervical Spine 1. New York: Springer-Verlag, 1987:322- 327.
  • Isik HS, Sandal E, Cagli S. Clinical Outcomes of Posterior C1 and C2 Screw-Rod Fixation for Atlantoaxial Instability. Turk Neurosurg 2018; 28(4):602-609.
  • Rajinda P, Towiwat S, Chirappapha P. Comparison of outcomes after atlantoaxial fusion with C1 lateral mass-C2 pedicle screws and C1-C2 transarticular screws. Eur Spine J. 2017;26(4):1064-1072.
There are 19 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research articles
Authors

Durmuş Oğuz Karakoyun 0000-0002-1306-7584

Project Number no
Publication Date December 31, 2020
Published in Issue Year 2020 Volume: 6 Issue: 3

Cite

Vancouver Karakoyun DO. Clinical Results of Harms Technique in Atlantoaxial Instability Treatment. Mid Blac Sea J Health Sci. 2020;6(3):294-8.

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