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Vol. 22. Issue 2.
Pages 140-149 (January 2011)
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Vol. 22. Issue 2.
Pages 140-149 (January 2011)
Artrodesis posterior C1–C2. Experiencia en fijación transarticular e interarticular en 36 pacientes
Posterior C1–C2 arthrodesis. Experience in transarticular and interarticular fixation in 36 patients
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A. Bescós, J. Muñoz, S. Colet, C.J. Domínguez, I. Cardiel, R. Florensa
Servicio Neurocirugía. Hospital Universitario Germans Trias i Pujol. Badalona
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Resumen
Objetivo

La estabilización del segmento C1–C2 ha ido evolucionando con la aparición de numerosas técnicas desde la fijación sublaminar, transarticular o interarticular y en los últimos tiempos con la introducción de sistemas de neuronavegación. El objetivo del estudio fue revisar los pacientes tratados en nuestro centro con fijación transarticular e interarticular y comparar los resultados obtenidos con las 2 técnicas.

Métodos

Se analizaron retrospectivamente 36 pacientes con inestabilidad C1–C2 que requirieron fijación quirúrgica entre 1995–2008. Las causas de la inestabilidad fueron en su mayoría traumáticas (18 pacientes) o degenerativas (16 pacientes) y 2 casos de neoplasia. En un primer periodo (1995–2001) se trataron 20 pacientes mediante fijación transarticular (técnica Magerl), y posteriormente (2002–2008) con fijación interarticular (técnica Goel-Harms) en otros 16 pacientes. Se obtuvieron datos sobre las complicaciones, evolución radiológica y resultados clínicos (escala EVA dolor) y funcionales (Escala PROLO) a los 3, 6, 12 y >12 meses tras la cirugía, así como la movilidad cervical postquirúrgica y los signos de fusión ósea. Se consideró resultado bueno si existía mejoría clínica con disminución en la escala EVA de dolor >5 puntos y funcional si se obtenía PROLO ≥4, regular si disminución de EVA pero <5 y PROLO ≤3, y malo si no había mejoría clínica ni funcional. Se compararon los resultados estadísticamente entre una y otra técnica.

Resultados

De 20 pacientes tratados con fijación transarticular se obtuvieron resultados buenos en 17 casos (85%), regular en 2 (10%) y malo en 1 (5%). Como complicaciones 1 caso de lesión de arteria vertebral y en 3 malposición de tornillos. En cuanto a los tratados con fijación interarticular en 14 (89%) se obtuvieron un buen resultado, y regular en 2 (12.5%), con 1 caso de malposición de tornillos y otro de infección postquirúrgica. No se registraron diferencias estadísticamente significativas entre ambas técnicas, aunque en los tratados con fijación interarticular hubo mayor tasa de fusión ósea y no se dieron casos de lesión de arteria vertebral.

Conclusiones

La fijación C1–C2 transarticular e interarticular resulta segura, presentando altas tasas de buenos resultados con pocas complicaciones. La introducción de sistemas de neuronavegación podría incrementar la eficacia y la seguridad de éstas técnicas.

Palabras clave:
Fijación transarticular
Fijación interarticular
Inestabilidad C1–C2
Fractura Hangman
Lesión arteria vertebral
Summary
Objective

The stabilization of C1–C2 segment has evolved with the appearance of several techniques from sublaminar, transarticular or interarticular fixation and over recent years with the introduction of neuronavegation systems. The aim of the study was to review patients treated in our center with transarticular and interarticualr fixation and compare the results obtained with both techniques.

Methods

Thirty six patients with C1–C2 instability that required a surgical fixation between 1995–2008 were retrostpectively analized. The causes of instability were principaly traumatic (18 cases) or degeneritive (16) and two cases of neoplasic lesions. In the first period (1995–2001) 20 patients were treated with transarticular fixation (Magerl's technique), and later (2002–2008) with interarticular fixation (Goel-Harms technique) in another 16 patients. Data was obtainned regarding complications, radiological evolution and clinical results (EVA pain score) and functionals (PROLO score) at 3, 6, 12 and >12 months post-op, as well as post-op cervical mobility and signs of bone fusion. A good result was considered if clinical improvement exis ted with decrease in EVA pain score > 5 points and funcional if a PROLO score > 4, regular if EVA decreased but <5 and PROLO <3, and bad if there was no clinical or functional improvement. The results were statistically compared between both techniques.

Results

Of the 20 patients treated with transarticular fixation, good results were obtained in 17 cases (85%), regular in 2 (10%), and bad in 1 (5%). Complications included 1 case of vertebral artery lesion and 3 screw misplacements, one case in contact with vertebral artery. Regarding those treated with interarticualr fixation, in 14 (89%), good results were obtained, regular in 2 (12.5%) with 1 case of screw misplacement and another of postsurgical infection. No statistical significant differences were recorded between both techniques, although in those treated with interarticular fixation there was a higher rate of bone fusion and no cases of vertebral arterial lesions were recorded.

Conclusions

Transarticular and interarticular C1–C2 fixation is safe and provides a high rate of good results with few complications. The introduction of neuronavigation systems can increase the efficacy and safety of these techniques.

Keywords:
Transarticular fixation
Interarticular fixation
C1–C2 instability
Hangman's fracture
Vertebral artery injury

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