• Robert E Elliott, Omar Tanweer, Akwasi Boah, Amr Morsi, Tracy Ma, Michael L Smith, and Anthony Frempong-Boadu.
• Neurosurgical Care, LLC, Royersford, Pennsylvania. Electronic address: robertelliottmd@gmail.com.
• World Neurosurg. 2014 Feb 1;81(2):411-21.

ObjectiveTo review published series describing C1-2 posterior instrumented fusions and summarize clinical and radiographic outcomes of patients treated with screw-rod constructs (SRC).MethodsOnline databases were searched for English-language articles published between 1991 and April 2011 describing posterior atlantoaxial instrumentation with C1-2 SRC. There were 24 studies including 1073 patients treated with SRC that fulfilled inclusion criteria. Meta-analysis techniques were used to compare outcomes.ResultsAll studies provided class III evidence. The 30-day perioperative mortality rate was 0.6%, and neurologic injury occurred in two patients with vertebral artery injury (VAI) from screw malpositions (0.2%). The incidence of clinically significant screw malpositions was 2.4% (confidence interval [CI], 1.1%-4.1%), the incidence of VAI was 2.0% (CI, 1.1%-3.4%), and the rate of fusion with the SRC technique was 97.5% (CI, 95.9%-98.5%).ConclusionsSRC is a safe and effective treatment option for C1-2 instability. The low but nonzero incidence of screw malposition and VAI emphasizes the necessity of having a thorough knowledge of atlantoaxial anatomy for successful insertion of screws.Copyright © 2014 Elsevier Inc. All rights reserved.

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