Different fusion techniques are used to treat atlantoaxial instability, including posterior wiring, interlaminar clamps, C1–C2 TAS, the Harms technique, and crossing C2 ILS technique. However, variants of the VA is relatively common; therefore, there is an urgent need for personalized fixation combinations. Unilateral TAS and contralateral C2PS combined with bilateral C1 LMS and C2ILS and TAS combined with bilateral C1LH have been used as alternatives to traditional techniques. The biomechanics of these two fixation combinations have been confirmed. In addition, a combination of bilateral C1LH and C2ILS is considered a good choice in terms of biomechanics and VA safety.
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