Atlanto-axial fusion for instability.

The problem of how best to treat a patient with instability of the atlanto-axial complex is still somewhat controversial. In this follow-up study of fifty-nine patients, nineteen were treated by a plaster jacket and brace; eleven, by single midline wiring and onlay bone grafts; and thirty, by four circumferential wires around the posterior elements of the axis and atlas with two bone grafts wedged between these elements on each side according to the method described by Brooks and Jenkins. (One patient had both types of fusion.) Although direct comparison of the results of treatment in three groups was not possible because of the many variables that may have influenced the results, the incidence of solid fusion was distinctly higher after the Brooks fusions despite less postoperative immobilization.