From the Research
C1-C2 fusion is most often performed using a posterior approach. This surgical technique is preferred for C1-C2 fusion because it provides better access to the posterior elements of these vertebrae, which are the primary stabilizing structures. The posterior approach allows surgeons to directly visualize and manipulate the C1-C2 joint complex, including the lateral masses and the pedicles, which serve as excellent anchor points for screws and other fixation devices.
Key Points
- The posterior approach for C1-C2 fusion has been refined over decades of surgical experience, with well-established techniques like the Harms technique (C1 lateral mass and C2 pedicle screws) and the Goel-Harms technique providing reliable fusion rates and good clinical outcomes for conditions such as atlantoaxial instability, rheumatoid arthritis affecting the C1-C2 joint, and traumatic injuries to the upper cervical spine 1, 2.
- While anterior approaches to the upper cervical spine are technically possible, they present significant challenges due to the complex anatomy of the region, including the proximity of vital neurovascular structures such as the vertebral arteries, spinal cord, and lower cranial nerves.
- A study published in 2017 found that a posterior approach with intra-articular arthrodesis and instrumentation fixation resulted in successful fusion in all patients, with no vertebral artery or spinal cord injuries reported 2.
- Another study published in 2008 found that the Harms technique, which involves posterior C1-C2 fusion using polyaxial screws and rods, resulted in radiographic evidence of fusion or lack of motion on flexion and extension films in all but 2 patients with at least a 12-month follow-up 1.
- The most recent and highest quality study, published in 2017, supports the use of a posterior approach for C1-C2 fusion, with a focus on intra-articular arthrodesis complementing instrumentation fixation 2.
Surgical Techniques
- The Harms technique, which involves posterior C1-C2 fusion using polyaxial screws and rods, is a well-established technique that provides reliable fusion rates and good clinical outcomes.
- The Goel-Harms technique is another well-established technique that involves posterior C1-C2 fusion using polyaxial screws and rods.
- A minimally invasive muscle-splitting approach has also been described, which allows for visualization of the relevant anatomy and placement of mini polyaxial screws in C1 lateral mass and C2 pars interarticularis 3.