Clinicoradiological outcomes of Goel and Harms fixation for atlantoaxial instability: An institutional experience
- Department of Spine Service, Indian Spinal Injuries Center, New Delhi, India.
DOI:10.25259/SNI_350_2020Copyright: © 2020 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Jeevan Kumar Sharma, Kalyan Kumar Varma Kalidindi, Gururaj Sangondimath, Abhinandan Reddy Mallepally, Nandan Marathe, Harvinder Singh Chhabra. Clinicoradiological outcomes of Goel and Harms fixation for atlantoaxial instability: An institutional experience. 11-Jul-2020;11:189
How to cite this URL: Jeevan Kumar Sharma, Kalyan Kumar Varma Kalidindi, Gururaj Sangondimath, Abhinandan Reddy Mallepally, Nandan Marathe, Harvinder Singh Chhabra. Clinicoradiological outcomes of Goel and Harms fixation for atlantoaxial instability: An institutional experience. 11-Jul-2020;11:189. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=10131
Background: Few studies have reported on the long-term outcomes of Goel and Harms C1-C2 fusions in the Asian population.
Methods: This was a retrospective analysis of 53 patients undergoing Goel and Harms fixation (2010 –2018). Clinical outcomes were assessed utilizing the neck disability index (NDI), Japanese Orthopedic Association (JOA) score, and visual analog scale (VAS). Outcomes were then correlated with fusion rates (using dynamic X-rays), atlanto-dens interval (ADI), and space available for cord (SAC) data.
Results: The study’s 53 patients averaged 49.98 years of age and included 42 males and 11 females. The mean preoperative versus postoperative scores on multiple outcome measures showed NDI 31.62 ± 11.05 versus decreased to 8.68 ± 3.76 post, mean JOA score (e.g., in 41 patients with myelopathy) improved from 13.20 ± 3.96 to 15.2 ± 2.17, and the mean VAS decreased from 4.85 ± 1.03 to 1.02 ± 0.87 and showed restoration of the ADI (1.96 ± 0.35 mm) and SAC (20.42 ± 0.35 mm). A 98.13% rate of C1-C2 fusion was achieved at 12 postoperative months.
Conclusion: Goel and Harms technique for C1-C2 fusion resulted in both good clinical and radiological outcomes.
Keywords: Atlantoaxial, Cervical spine, Goel’s technique, Harms, Instability
There are various techniques available for atlantoaxial (A-A) arthrodesis.[
We performed a retrospective analysis of clinical and radiological data for 57 patients who underwent Goel and Harms C1-C2 fusions for various pathologies (2010–2018) [
Surgical protocol followed in our institute
Dynamic X-rays were used to assess the instability of C1-C2. The diameter of the C2 pedicle was assessed on preoperative CT scan and the CTA documented whether or not there was a high riding vertebral artery. C2 pedicle/pars screws and C1 lateral mass screws were used for fixation, and rods were connected to the screws. Clinical outcomes and dynamic X-rays were performed at 3rd months, 6th months, and then yearly.
The mean follow-up duration was 48.90 ± 24.78 months (12–96 months).
For 53 patients undergoing various surgical procedures, 43 patients had signs of myelopathy. The mean operative time was 175.09 ± 58.21 min, the average blood loss was 143.02 ± 91.38 ml, and the average length of stay was10.85 ± 10.61 days [
Postoperatively, the improvement was seen on the JOA, VAS, and NDI scores, while radiological improvement was noted (e.g., X-rays and/or MR) on the ADI and SAC measures [
There were six complications; a patient with Os- odontoideum deteriorated postoperatively from AIS-E to AIS-C but improved to AIS-D 3 months later, two sustained intraoperative or postoperative CSF leaks, two patients had to undergo revision surgery [
Gallie, Brooks, and Jenkins used bone grafts for C1-C2 fusion with sublaminar wires to provide A-A stability.[
The Goel and Harms technique was a safe and effective technique for treating A-A (C1-C2) instability in the Asian population.
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