{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T08:12:24Z","timestamp":1769760744976,"version":"3.49.0"},"reference-count":41,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,1,12]],"date-time":"2022-01-12T00:00:00Z","timestamp":1641945600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Posterior C1\u2013C2 fixation, with trans-articular screws (TAS) or screw-rod-construct (SRC), is the main surgical technique for atlantoaxial instability, and can be performed with a fluoroscopy-assisted free-handed technique or 3D navigation. This study aimed to evaluate complications, radiological and functional outcome in patients treated with a fluoroscopy-assisted technique. Materials and Methods: A single-center consecutive cohort study was conducted of all adult patients who underwent posterior C1\u2013C2 fixation, using TAS or CRS, between 2005\u20132019. Results: Seventy-eight patients were included, with a median follow-up time of 6.8 years. Trauma was the most common injury mechanism (64%), and cervicalgia the predominant preoperative symptom (88%). TAS was used in 33%, and SRC in 67% of cases. Surgery was associated with a significant reduction in cervicalgia (from 88% to 26%, p &lt; 0.001). The most common complications were vertebral artery injury (n = 2, 2.6%), and screw malposition (n = 5, 6.7%, of which 2 were TAS and 3 were SRC). No patients deteriorated in their functional status following surgery. Conclusions: Fluoroscopy-assisted C1\u2013C2 fixation with TAS or SRC is a safe and effective treatment for atlantoaxial instability, with a low complication rate, few surgical revisions, and pain relief in the majority of the cases.<\/jats:p>","DOI":"10.3390\/medicina58010114","type":"journal-article","created":{"date-parts":[[2022,1,12]],"date-time":"2022-01-12T23:17:07Z","timestamp":1642029427000},"page":"114","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Fluoroscopy-Assisted C1\u2013C2 Posterior Fixation for Atlantoaxial Instability: A Single-Center Case Series of 78 Patients"],"prefix":"10.3390","volume":"58","author":[{"given":"Charles","family":"Tatter","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden"},{"name":"Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Fletcher-Sandersj\u00f6\u00f6","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden"},{"name":"Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oscar","family":"Persson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden"},{"name":"Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gustav","family":"Burstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden"},{"name":"Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8781-1169","authenticated-orcid":false,"given":"Erik","family":"Edstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden"},{"name":"Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3776-6136","authenticated-orcid":false,"given":"Adrian","family":"Elmi-Terander","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden"},{"name":"Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"A68","DOI":"10.1227\/01.NEU.0000366118.21964.A8","article-title":"Axis Fractures","volume":"66","author":"Pryputniewicz","year":"2010","journal-title":"Neurosurgery"},{"key":"ref_2","first-page":"24","article-title":"Cervical spine instability in rheumatoid arthritis","volume":"24","author":"Neves","year":"2013","journal-title":"Eur. 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