Objective To evaluate the screw placement guided by C-arm computer navigation in the fixation and fusion of instability of the atlantoaxial joint using atlantoaxial pedicle screws.Methods A retrospective study was conducted to analyze the clinical data of 30 patients who had been treated for atlantoaxi-al instability by pedicle screw fixation and fusion at Department of Orthopaedics,The First Affiliated Hospital of Zhengzhou University from October 2020 to November 2022.The patients were divided into 2 groups according to whether the C-arm computer navigation system had been used to assist their screw placement.In the observa-tion group,there were 12 patients[9 males and 3 females with an age of(55.6±7.3)years]whose screw placement was assisted by C-arm computer navigation;in the control group,there were 18 patients[13 males and 5 females with an age of(52.4±8.1)years]whose screw placement was assisted by conventional X-ray fluoroscopy.The 2 groups were compared in terms of surgery time,intraoperative bleeding volume,intraopera-tive fluoroscopy time,incidence of postoperative complications,and neck disability index(NDI)and visual ana-logue scale(VAS)at 3 months after surgery.Results The 2 groups were comparable because there were no significant differences in the preoperative general data between them(P＞0.05).All the 30 patients were followed up for(23.8±6.1)months after surgery.The surgery time,intraoperative fluoroscopy time,and intra-operative bleeding volume in the observation group were significantly shorter or smaller,respectively,than those in the control group[(109.5±19.3)min versus(135.6±23.2)min;(43.5±11.7)s versus(68.8±24.5)s;(240.6±65.8)mL versus(320.4±95.6)mL)](P＜0.05).No vascular or neural in-juries or other complications occurred in any of the patients.There was no statistically significant difference be-tween the observation group and the control group in the NDI or VAS pain score at 3 months after surgery[(18.6±7.3)points versus(20.4±9.3)points;(1.6±0.6)points versus(1.4±0.5)points](P＞0.05).Follow-ups observed no loosening or breakage of implants,no recurrence of instability of the atlantoaxial joint,or no nonunion of the bone grafts.Conclusion In the treatment of atlantoaxial instability with at-lantoaxial pedicle screw fixation and fusion,compared with conventional X-ray fluoroscopy guidance,the screw placement guided by C-arm computer navigation can result in the same therapeutic efficacy but shorter surgery time,less intraoperative blood loss and less radiation exposure.
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