• Robert E Elliott, Omar Tanweer, Akwasi Boah, Amr Morsi, Tracy Ma, Anthony Frempong-Boadu, and Michael L Smith.
• Neurosurgical Care, LLC, Royersford, Pennsylvania, USA. Electronic address: robertelliottmd@gmail.com.
• World Neurosurg. 2013 Nov 1;80(5):627-41.

ObjectiveTo review published series describing C1-2 posterior instrumented fusions and summarize clinical and radiographic outcomes of patients treated with transarticular screw (TAS) fixation.MethodsOnline databases were searched for English-language articles published between 1986 and April 2011 describing posterior atlantoaxial instrumentation with C1-2 TAS fixation. There were 45 studies including 2073 patients treated with TAS that fulfilled inclusion criteria. Meta-analysis techniques were used to calculate outcomes.ResultsAll studies provided class III evidence. The 30-day perioperative mortality rate was 0.8%, and the incidence of neurologic injury was 0.2%. The incidence of clinically significant malpositioned screws was 7.1% (confidence interval [CI], 5.7%-8.8%), the incidence of vertebral artery injury was 3.1% (CI, 2.3%-4.3%), and the rate of fusion with the TAS technique was 94.6% (CI, 92.6%-96.1%).ConclusionsTAS fixation is a safe and effective treatment option for C1-2 instability with high rates of fusion (approximately 95%). Screw malposition and vertebral artery injury occurred in approximately 5% of patients. The successful insertion of TAS requires a thorough knowledge of atlantoaxial anatomy.Copyright © 2013 Elsevier Inc. All rights reserved.

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