Study on C1-C2 Goel-Harms Fixation: A Free Hand Technique

Short historical description of the evolution of C1-C2 fixation methods, anatomical tricks and free hand Goel-Harms fixation technique description. A series of 7 patients were operated using free hand technique, X-rays were used only after the positioning of the patient in ventral position with Mayfield and at the end before locking the lateral rods. The fixation C1-C2 was performed in free hand manner.

No complication was documented, in all cases CT scan revealed correct and safe screw positioning (Gertzbein grade A). Our purpose was not the follow up of these patients, because the follow up of the patients treated by Goel-Harms was reported in different articles before, the main goal is technique description and its popularization.

Using the anatomical landmarks and with a good preoperative planning, it is easy for the experienced surgeons to perform the technique in a free hand manner, avoiding X-ray exposure to the patient and the team. This technique is safe, reduce significantly the surgical time, the rate of complication in this small series is nil, but even though is not recommended as usual use for the surgeons with little experience in this field. The surgeons in the residency program could learn the technique from the seniors already practicing it. Understanding of the anatomic subtleties, the surgical duration of C1-C2 free hand fixation can be minimized, as well as blood loss, making this type of surgery very practical, effective and safe. Preoperative anatomic recognition for surgical planning and intraoperative additional measurements and tactile assessment ensures accurate C1 and C2 free hand screw placement and adequate length of the screws. The use of the drilling of the interarticular space C1-C2 and packing with bone graft from the spinous process of C2 vertebra with subsequent insertion of the spacer (screw from anterior cervical plate system, 12-14mm length) enhances the stability of the fixation and fusion rate.