Abstract
Study Design Retrospective analysis.
Clinical Question Is there a difference between the screw–rod construct (SRC) procedure without wiring
and the SRC procedure with wiring with respect to fusion, implant failure, reoperation,
donor-site morbidity, and complication rates?
Patients and Methods We performed a retrospective analysis of 26 patients who underwent C1–2 fixation
between 2004 and 2012 (SRC with wiring and structural bone graft, 13 patients; SRC
with autograft but without wiring, 13 patients). Fusion was assessed using dynamic
X-rays in all patients and computed tomographic scans in selected cases. Pseudoarthrosis
was confirmed during reoperation.
Results The mean follow-up time was 2 years and 5 months for the SRC without wiring group
and 2 years and 1 month for the SRC with wiring group. Patients with less than 1-year
follow-up time were excluded. The fusion rate, implant failure rate, and reoperation
rates for the SRC without wiring group were 92, 8, and 8%, respectively. The fusion,
implant failure, and reoperation rates for the SRC with wiring group were 100, 0,
and 0%, respectively. There were no donor-site morbidities or complications in either
group (both 0%). There were no differences in parameters we examined between the two
groups (p > 0.05 for each rate, Fisher exact test).
Conclusions The results suggest that supplementing the SRC procedure with wiring may increase
fusion rate, but this difference is not statistically significant. Although the sample
size was small, there was not a significant discrepancy in outcomes between the two
groups at an average follow-up of 2 years.
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Final class of evidence (CoE)—treatment
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Yes
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Study Design
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RCT
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Cohort
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X
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Case-control
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Case series
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Methods
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Concealed allocation (RCT)
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Intention to treat (RCT)
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Blinded/independent evaluation of primary outcome
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F/U ≥ 85%
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Adequate sample size
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Control for confounding
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Overall class of evidence
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III
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Keywords
SRC - posterior wiring - Harms technique - atlantoaxial instability - C1 - C2 - fusion
- screw rod construct
