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Intraarticular atlantooccipital fusion for the treatment of traumatic occipitocervical dislocation in a child: a new technique for selective stabilization with nine years follow-up.

Abstract：

STUDY DESIGN:A case report of traumatic atlantooccipital dislocation (AOD) managed by intraarticular-posterior fusion from a posterior approach at the C0-C1 level with preservation of C1-C2 motion. OBJECTIVE:To present a new technique for atlantooccipital fusion with long-term follow-up. SUMMARY OF BACKGROUND DATA:There is an increasing number of patients with AOD who have preservation of neurologic function. The most frequent method used to treat this condition is occipitocervical fusion. There has been a tendency in recent years to minimize the extent of stabilization, performing occipitoatlantal fusion only. However, it is difficult to achieve a solid fusion between C0 and C1, and the long-term effect of the insufficiency of lig. alaria on C0-C2 stability is unknown. The authors present a modified technique of C0-C1 fusion that aims to enhance fusion and achieve greater stability. METHODS:A 11-year-old child with AOD was initially treated unsuccessfully with a halo device for 3 months. As instability persisted, an isolated C0-C1 fusion was performed from a posterior approach. This anatomically based intraarticular fusion technique comprises removal of the articular cartilage of the atlantooccipital joints, and cancellous bone autografting at the atlantooccipital joints and between the occiput and posterior arch of C1, supported by an occipital plate linked by rods to lateral mass screws in the atlas. RESULTS:This technique of increased bony fusion surface and internal fixation provided an excellent result with full recovery of minor neurologic deficits. At long-term follow-up, 9 years after surgery, the patient was free of signs and symptoms; solid fusion of the C0-C1 joint, and normal values for rotation of the C1-C2 segment were recorded. CONCLUSION:Intraarticular and posterior fusion of the atlantooccipital joint was able to provide an excellent long-term clinical outcome in the treatment of traumatic AOD in a child. This is the first report of an intraarticular fusion of the C0-C1 segment and the longest follow-up published on isolated C0-C1 stabilization.

journal_name

Spine (Phila Pa 1976)

journal_title

Spine

authors

Jeszenszky D,Fekete TF,Lattig F,Bognár L

doi

10.1097/BRS.0b013e3181c91fa1

subject

Has Abstract

pub_date

2010-05-01 00:00:00

pages

E421-6

issue

eissn

0362-2436

issn

1528-1159

journal_volume

pub_type

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Intraarticular atlantooccipital fusion for the treatment of traumatic occipitocervical dislocation in a child: a new technique for selective stabilization with nine years follow-up.