Comparison of C1-C2 fixation techniques: Magerl technique vs Goel-Harms technique

(Vergara P, Bal JS, Hickman Casey AT, Crockard HA, Choi D. C1-C2 Posterior Fixation: Are Four Screws Better Than Two? Neurosurgery. 2011 Nov 22)

Vergara et al. from London reported that Goel-Harms technique (segmental fixation of C1-C2 using 4 screws) is safer than Magerl technique. The authors evaluate the pros and cons of the most popular C1-C2 posterior fixation techniques: C1 lateral mass-C2 pedicle screw and rods (Goel-Harms) and transarticular screw (Magerl) fixations. The authors state that:

"METHODS: Retrospective review of 122 patients who underwent Harms' or Magerl's fixation for atlanto-axial instability. Surgical, clinical and radiological outcomes were compared in the two groups.
RESULTS: 123 operations were performed, of which 47 were by Harms' technique (Group-H) and 76 by Magerl's technique (Group-M). No significant differences were found in duration of surgery, blood loss, post-operative pain and length of hospitalization. Post-operatively, neck pain, C2-radiculopathy and hand function improved in both groups, with better, but not statistically significant, results for Group H. The intraoperative complication rate was 2.1% in Group H and 21% in Group M (p<0.05); postoperative complication rate was 10.6% in Group H and 21% in Group M (p>0.05). The major complications were vertebral artery injury (2.1% in Group H, 13.1% in Group M, p=0.05) and screw fracture (2.1% in Group H, 9.2% in Group M, p>0.05). Fusion rate at the end of follow-up was not-significantly higher in Group H. C1-C2 range of movements in flexion/extension at the end of follow-up was lower in Group H (p=0.017).
CONCLUSION: Magerl's with posterior wiring and Harms' techniques are both effective options for stabilizing the atlanto-axial complex. However, Harms' technique appears to be safer, with fewer complications, and a more robust long-term fixation."

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