A combined four-point atlantoaxial fixation using Magerl and Harms techniques for the treatment of C1-C2 instability: a case report

Background: The instability of the first and second cervical vertebral complexes (C1-C2) can have a variety of etiologies, generally involving the C1-C2 axis and associated soft tissues. Case Presentation: A 52-year-old man presented to our emergency department with cervical spine pain and limited range of motion following cervical spine trauma from a fall. The computed tomography scan with good reconstruction showed a complex C2 fracture. After obtaining informed consent, a combined C1 lateral mass-C2 pedicular screw fixation and C1-C2 transarticular screw rod fixation were applied as a four-point fixation technique to achieve immediate rigid immobilization of the C1-C2 motion segment. Conclusion: Transarticular screw fixation is an effective technique for the fusion of atlantoaxial complex that provides good fusion rates and is particularly important in patients at risk of nonunion. Nonetheless, a complementary fixation and grafting system is required to improve the integrity of the technique. The authors conclude that combined C1 lateral mass-C2 pedicular screw fixation (Harms techniques), and C1-C2 transarticular polyaxial screw rod fixation is a novel and effective four-point fixation technique to achieve immediate rigid immobilization of the C1-C2 motion segment. Further biomechanical studies should be performed to substantiate our clinical results.