C1-C2 Fusion

Operation
Atlanto-axial fusion, Harms C1-C2 fusion, C1 lateral mass screw to C2 pars screw fusion

Indication
Fracture of odontoid peg, non-union of C2 fracture, atlanto-axial instability

Pre-Assessment
Required

Special preparation for surgery
Imaging of area, MRI and CT scan occasionally vascular studies.
Stop all blood thinning medications including aspirin, warfarin, clopidogrel.
Stop HRT and oral contraceptives. Stop some herbal medicines.
You will be advised when to stop these medications.

Admission to hospital
On day of surgery

General anesthetic
Yes

Operation position
Fracture table and Mayfield skull traction holding system

Details of operation
The patient is lying face down and a midline posterior cervical incision is required. Dissection is achieved to expose the bones of the posterior arch of C1 and C2. Careful dissection of the tissues between the lateral mass of C1 and the pars of C2 to allow placement of the C1 lateral mass screw under image intensification guidance and the C2 pars screw. These are linked with a rod system. Bone graft is applied to the prepared posterior arch structures of C1 and C2.

Length of surgery
2-3hrs

Urinary catheter required
Yes

Post-operative drain required
Occasionally

Post-operative antibiotics
Yes

Post-operative iv fluids (drip)
Yes

DVT prophylaxis
Yes

Mobilization after surgery
Next day

Length of stay in hospital
Two-three days

Post hospital recovery
Two to four weeks

Sutures removed
Dissolvable

Dressing
Glue dressings

Review appointment
6 weeks

Physiotherapy
Yes

Return to driving
4 weeks

Return to work
6 weeks