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Preoperative radiological findings and surgical results of 13 bidirectional anterior and posterior atlantoaxial subluxation (AAS) cases and 11 unidirectional anterior AAS cases were compared. Bidirectional AAS showed more angular instability of the atlantoaxial joint than anterior AAS (p<0.005).Four bidirectional AAS cases and 4 anterior AAS cases, who were treated using the modified McGraw method combined with Magerl's transarticular fixation of C1/2, achieved solid union except for three cases with hypoplastic C1 posterior arches. This combined method was useful for a RA patient, whose spinal cord was compressed statically by synovitis of the odontoid process even when the neck was in a neutral position.

Comparison between McGraw Method and Modified McGraw Method Combined with Magerl's Transarticular Fixation for Atlantoaxial Subluxation.