Outcomes Following Arthrodesis for Atlanto-Axial Osteoarthritis.

Abstract

STUDY DESIGN:

Retrospective analysis.

OBJECTIVE:

We set out to evaluate the radiographic and patient-reported outcomes following C1-C2 arthrodesis for atlantoaxial osteoarthritis (AAOA) using modern instrumentation and techniques.

SUMMARY OF BACKGROUND DATA:

Few studies have evaluated outcomes following C1-C2 arthrodesis for AAOA using modern surgical fixation techniques.

METHODS:

Retrospective analysis of all patients following C1-C2 arthrodesis with recalcitrant AAOA from a single center, single surgeon from 2002 to 2012. Preoperative, immediate and final follow-up postoperative radiographic images were evaluated. Patient-reported outcomes scores were assessed preoperative, 1-year, and final postoperative follow-up.

RESULTS:

We found a total of 14 patients (13 female, 1 male) with average follow-up of 2.96 ± 2.26 years and mean age at surgery of 71.8 ± 9.3 years old. The most common construct was posterior C1-C2 bilateral screw-rod construct (SRC) (n = 9), and there were 3 patients with transarticular screw (TAS) constructs, and 2 patients with hybrid fixation (unilateral SRC and contralateral TAS). Mean change from baseline to final follow-up for Numeric Pain Rating Scale (NRS) was -4.7 ± 2.1, and Neck Disability Index (NDI) was -21.0 ± 13.6, with 11 (78.6%) patients demonstrated a substantial clinical benefit (change in NDI ≥ 10). There were no differences from baseline to all follow-up time points for SF-12 Physical and Mental Component Scores. All patients had evidence of solid C1-C2 arthrodesis and stable fixation at final follow-up, with no significant change in subaxial sagittal alignment. There were no perioperative or postoperative complications.

CONCLUSION:

We report one of the largest series evaluating patient-reported outcomes in patients following arthrodesis for AAOA using modern C1-C2 fixation techniques. Our study found C1-C2 arthrodesis for AAOA to be safe and effective, with a significant improvement in patient-reported pain and neck disability and most patients reporting substantial clinical benefit.

LEVEL OF EVIDENCE:

4.

• Authors: Daniel G Kang, Ronald A Lehman Jr, Scott C Wagner, Colleen Peters, K Daniel Riew
• Journal: Spine (Spine (Phila Pa 1976)) Vol. 42 Issue 5 Pg. E294-E303 (Mar 2017) ISSN: 1528-1159 [Electronic] United States
• PMID: 28244970 (Publication Type: Journal Article)

Topics

• Aged
• Aged, 80 and over
• Arthrodesis (methods)
• Bone Screws (adverse effects)
• Cervical Vertebrae (surgery)
• Female
• Humans
• Joint Instability (surgery)
• Male
• Middle Aged
• Neck (surgery)
• Neck Pain (etiology, surgery)
• Osteoarthritis (surgery)
• Retrospective Studies
• Spinal Fusion (methods)
• Treatment Outcome