One-step fixation of atlantoaxial rotatory subluxation: technical note and report of three cases.

Abstract:

OBJECTIVE:To describe a successful one-step intraoperative reduction of atlantoaxial rotatory subluxation (AARS) using neuromuscular blockade and intraoperative traction. METHODS:While the patient was undergoing continuous somatosensory evoked potential monitoring, crown halo traction was applied under general anesthesia. A muscle relaxant was administered, and an intraoperative computed tomography scan was performed using the O-arm Surgical Imaging System in the supine position verifying adequate reduction. The patient was placed in the prone position, and a repeat image was obtained verifying persistent reduction in the position that the patient would undergo dorsal fixation. Occipitocervical fixation was then performed. RESULTS:This technique was performed successfully in three pediatric patients with chronic AARS. There were no complications related to the procedure. CONCLUSIONS:Intraoperative traction and neuromuscular blockade achieved a one-step reduction before fixation for subacute and chronic irreducible AARS. This one-step reduction obviates preoperative traction, which is often inconvenient and not tolerated by pediatric patients. Successful reduction is also demonstrated in detail intraoperatively with three-dimensional imaging.

journal_name

World Neurosurg

journal_title

World neurosurgery

authors

Dahdaleh NS,Dlouhy BJ,Menezes AH

doi

10.1016/j.wneu.2012.11.040

subject

Has Abstract

pub_date

2013-12-01 00:00:00

pages

e391-5

issue

6

eissn

1878-8750

issn

1878-8769

pii

S1878-8750(12)01329-0

journal_volume

80

pub_type

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