Sicherheit und Ergebnisse der dorsalen Stabilisierung nach Goel-Harms in sitzender Position bei Densfrakturen ohne Navigation

Fractures of odontoid account for about 10–15% of all cervical spine fractures. Type II fractures are unstable and carry a morbidity and mortality rate of roughly 6%. Numerous techniques exist for C1/C2 stabilization, but the goal of this paper is to evaluate the safety and effectiveness of a modified Goel-Harms procedure performed freehand under lateral fluoroscopy in the sitting position.

This retrospective study describes 161 consecutive patients between 2014 and 2023 who underwent C1–C2 fixation using a modified Goel-Harms technique in the sitting position, without navigation. Postoperative CT scans confirmed screw positioning. Screw placement was graded according to Gertzbein and Robbins. Surgery-related complications were recorded. Bony fusion was evaluated at 3 and 6 months.

A total of 161 patients (72 men [44.7%], 89 women [55.3%];mean age 77 years) underwent surgery with 644 screws placed. Seven patients with a persistent foramen ovale were operated in prone position and were therefore excluded. Preoperatively 116 patients (72.0%) reported neck pain, 10 (6.2%) radicular pain and 33 (20) patients had neurological deficits. In 53 cases (32.9%), extension to C3 was performed due to associated pars or pedicle fractures. 624 screws (96.8%) were Grade A and B, 16 (2.4%) Grade C, and 4 (0.6%) Grade D and E. Only these four screws required revision for misplacement. Dorsal decompression with a C1 laminectomy was performed in 21 patients (13%), and 6 (3.7%) underwent revision for wound healing disorder. Four C2 screws breached the vertebral artery canal but did not compress the artery (0,6%). Two patients experienced vertebral artery injuries with total occlusion on CTA due to screw misplacement (0,3%), however without resulting neurological deficits and therefore the screws were not revised. None of the patients experienced an intraoperative air embolism or developed new neurological deficits. The pain rate and intensity improved over time, but we did not have a reported pain scale to quantify the changes. Fusion rates reached 29.8% at 3 months and 62.1% at 6 months.

The modified Goel-Harms C1-C2 dorsal fixation performed in the sitting position under lateral fluoroscopy without navigation is a safe and straightforward technique with low complication rates. It should be considered a viable option in the surgical treatment of C1-C2 fractures. The surgeon's experience plays a critical role in the success of this procedure.