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Vol. 11. Issue 1.
Pages 43-49 (January 2000)
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Vol. 11. Issue 1.
Pages 43-49 (January 2000)
Atornillado transarticular posterior atloaxoideo en la inestabilidad del complejo CO-CI-C2
Posterior Cl-C2 transarticular screw fixation for instability of the CO-C2 complex
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S. Martín-Ferrer, J. Rimbau, MaC. Joly
Servicio de Neurocirugía. Hospital Universitario “Dr. Josep Trueta” Girona
J. Teruel*, J. Pont*
* Servicio de Radiología. Hospital Universitario “Dr. Josep Trueta”. Girona
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Resumen

Un seleccionado grupo de pacientes afectos de procesos traumáticos, malformativos, degenerativos, infecciosos o tumorales del complejo cervical alto que provocan una inestabilidad de este segmento, precisarán para su tratamiento una fijación interna. Sobre todo, en los casos con inestabilidad atloaxoidea la fijación mediante el atornillado posterior interarticular Cl-C2 suplementado a una artrodesis interlaminar Cl-C2 deberá considerarse como una opción terapéutica adecuada.

En nuestro servicio 6 pacientes han sido intervenidos mediante esta técnica, en otros 5 más la artrodesis interarticular se asoció a una fijación occipitocervical. La etiología que indicó el tratamiento quirúrgico fue pseudoartrosis de fracturas de la base de la odontoides en 3 casos, artritis reumatoide en 3, rotura del ligamento transverso del atlas en 2 y tumores de axis en 3. Todos los pacientes obtuvieron una triple fusión ósea interarticular e interlaminar. No hemos constatado ninguna complicación biomecánica, neurológica, infecciosa ni vascular. Nuestra limitada experiencia demuestra que esta técnica debe considerarse con fuerza en el tratamiento quirúrgico de algunos pacientes con inestabilidad del segmento cervical alto, en particular en el caso de reintervenciones tras el fracaso de otras técnicas.

Palabras clave:
Columna cervical
Inestabilidad atloaxoidea
Atornillado transarticular Cl-C2
Artrodesis interlaminar CI-C2
Artritis reumatoide
Summary

The management of patients with atlantoaxial instability remains a complex and challenging problem for neurosurgeons. Instability may result from congenital malformations, trauma, neoplasm, infection, rheumatoid subluxation or other degenerative diseases. Posterior Cl-C2 transarticular facet screw fixation with a supplemental bone-wire fusion has been advocated for the management of atlanto-axial instability.

We present our experience with 11 cases in which we have applied this technique. Atlantoaxial or CO-C2 instability was caused by odontoid pseudoarthrosis in 3 patients, transverse ligament disruption in 2, rheumatoid arthritis in 3 and tumors of the axis in 3. All 11 patients achieved solid osseous fusion. Progression of spinal deformity, screw pullout or breakage, and neurological, infection or vascular complications did not occur. This limited experience demonstrates that posterior transarticular screw fixation supplemented with an interspinous Cl-C2 wiring is an important option in the management of patients with atlantoaxial instability.

Key words:
Cervical spine
Atlanto-axial instability
CI-C2 transarticular screws
CI-C2 wiring
Rheumatoid arthritis

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