To The Editor:
We read the above-mentioned manuscript with considerable concern and we wish to bring to your notice certain facts. In 2001, Harms and Melcher published a paper on C1-2 fixation using
individual fixation of Cl lateral mass and C2 pedicle with screw and rods
(1). They described this technique of fixation as new and novel.
We had
brought to the attention of the journal Spine (2) that we were the first
to describe this technique and have used this method since 1987. Our experience now exceeds 300 cases during
the last 16 years. We have
multiple publications on this subject since 1994 indexed in Medline (3-
7,9) as well as in a textbook (8). Harms and Melcher chose not to respond
to our letter, which was subsequently published in Spine without the
authors' reply (2).
We are surprised to note that in this paper,
the authors still label this method as novel and new. The only difference
in the present manuscript is that the authors have made a passing
reference to our papers; which was missing in their earlier paper
published in Spine (1). If there is any difference
in their technique when compared to ours, it is that Harms and Melcher have used a commercially made
rod instead of the custom made plates that we use.
We have previously described the importance and relevance of sectioning of the
C2 ganglion for wide exposure of the region; the opening up of the
atlantoaxial facet joint and denuding the articular cartilage; and impacting bone graft into the joint space to provide stability to the
construct and enhance ultimate bone fusion.
In the present paper the authors have used an extension of C 1-2 fixation
by our technique and included the occipital bone in the fixation
construct. We also have described this construct in 1994 (7) and
subsequently in 1995 (3) and 1997 (8). All these presentations have line
drawings and case illustrations demonstrating the technique and its use in
a variety of clinical conditions.
We strongly believe that such omissions and misrepresentation of facts
are against the norms of intellectual honesty and compromise scientific validity. Nevertheless, we are happy to read this well-structured
manuscript, which validates our clinical experience and shows that the
construct based on our concepts has sufficient biomechanical strength.
Prof Atul Goel
Dr Arvind G. Kulkarni
References
I .Harms J, Melcher P. Posterior C 1-C2 Fusion with Polyaxial Screw and
Rod Fixation. Spine 2001;26: 2467-71.
2.Goel A, Laheri V. Posterior C1-C2 Fusion with Polyaxial Screw and Rod
Fixation. (Letter). Spine 2002;27:1589-1590
3.Goe1 A, Achawal S. Surgical treatment for Arnold Chiari malformation
associated with atlantoaxial dislocation. Br J Neurosurg 1. 995; 9: 67-72.
4.Goel A, Gupta S. Vertebral artery injury with transarticular screws
[letter]. J Neurosurg 1999; 90: 376-7.
5.Goel A, Gupta S. Quantitative anatomy of the lateral masses of atlas and
axis. Neurol India 2000; 48: 120-5.
6.Goel A, Laheri VK. Plate and screw fixation for atlanto-axial
dislocation [technical report]. Acta Neurochir (Wien) 1994; 129: 47-53.
7.Goe1 A., Muzumdar D, Dindorkar K, et al. Atlantoaxial dislocation
associated with stenosis of canal at atlas. J Postgrad Med 1997; 43: 75-7.
8.Goel A, Kobayashi S. Cramovertebral and spinal stability. In: Kobayashi
S, Goel A, Hongo K (eds). Neurosurgery of Complex Tumors and Vascular
Lesions. New York: Churchill Livingstone, 1997: 339-72.
9.Goel A, Desai KI, Muzumdar DP. Atlantoaxial fixation using plate and
screw method: A report of 160 treated patients. Neurosurgery 2002;51: 1351
-1357.
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