Name of the Procedure:

Arthrodesis, posterior technique, atlas-axis (C1-C2)

Summary

Arthrodesis, commonly known as spinal fusion, involves surgically fusing two or more vertebrae in the spine. When performed on the atlas (C1) and axis (C2) vertebrae, this procedure aims to stabilize the neck and alleviate pain.

Purpose

The primary purpose of this procedure is to treat instability and pain in the upper cervical spine (neck region). It is often done to correct congenital deformities, traumatic injuries, severe arthritis, infections, or tumors that affect C1-C2 stability.

Indications

• Severe neck pain due to instability
• Congenital conditions like atlantoaxial instability
• Traumatic fractures or dislocations
• Severe rheumatoid arthritis affecting the upper cervical spine
• Tumors or infections compromising vertebral stability

Preparation

• Patients may be required to fast for several hours before the procedure.
• Medications, especially blood thinners, may need to be adjusted or stopped.
• Preoperative imaging studies like X-rays, CT scans, or MRIs to evaluate the cervical spine.
• Pre-operative assessments including blood tests and cardiovascular evaluations.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made at the back of the neck to access the C1-C2 vertebrae.
3. The surgeon prepares the bone surfaces and places bone grafts between C1 and C2.
4. Instrumentation, such as screws and rods, is used to secure and stabilize the vertebrae.
5. The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes between 2 to 4 hours, depending on complexity.

Setting

Arthrodesis is performed in a hospital setting, often in an operating room equipped for spinal surgeries.

Personnel

• Orthopedic or neurosurgeon
• Anesthesiologist
• Surgical nurses
• Scrub technicians
• Radiologic technologist (if intraoperative imaging is used)

Risks and Complications

• Infection
• Bleeding
• Nerve damage or spinal cord injury
• Failure of the bones to fuse (nonunion)
• Hardware complications (e.g., loosening or breakage of instrumentation)
• Persistent pain or recurrence of symptoms

Benefits

• Stabilization of the cervical spine
• Reduction or elimination of neck pain
• Improved quality of life and functional ability
• Potential prevention of further spinal damage

Recovery

• Patients may need to wear a cervical collar for several weeks to support the neck.
• Pain medication and physical therapy may be prescribed.
• Activity restrictions, such as avoiding heavy lifting, for several weeks or months.
• Follow-up appointments for imaging studies to ensure successful fusion.

Alternatives

• Conservative treatments such as physical therapy, anti-inflammatory medications, or cervical traction.
• Minimally invasive procedures like injections or radiofrequency ablation.
• Each alternative has its own risks and benefits and is often considered based on the specific condition and patient preferences.

Patient Experience

• Patients can expect some pain and discomfort immediately after the procedure, usually managed with medications.
• Gradual improvement in symptoms as the fusion heals.
• Full recovery and return to normal activities may vary, typically spanning several months.