D Grob1. 1. Spine Unit, Schulthess Klinik, Zürich, Switzerland. gro@kws.ch
Abstract
STUDY DESIGN: A case report of traumatic atlanto-occipital dislocation managed by transarticular screw fixation. OBJECTIVES: To present a case with initial failed wire fixation but successful reduction and fixation with transarticular screw fixation and occipitocervical plate stabilization. SUMMARY OF BACKGROUND DATA: Atlanto-occipital dislocation is generally a fatal injury, except when it occurs in children. Management of this injury is difficult because of multidirectional instability and the problems associated with technical stabilization. METHODS: Intraoperative atlanto-occipital reduction was achieved and maintained by direct C0-C1 transarticular screw fixation. To protect this fixation, a posterior occipitocervical fusion at C0-C2 using a Y-plate was performed. RESULTS: The internal fixation and reduction were maintained, indicating a good surgical outcome, at examination 2 years after surgery. The initially severe neurologic deficit was reduced to some motor weakness of the right hand and weakness of oculomotor function. CONCLUSIONS: Anatomic reduction and reliable fixation with transarticular screws may provide satisfactory clinical results with important neurologic recovery in cases of atlanto-occipital dislocation.
STUDY DESIGN: A case report of traumatic atlanto-occipital dislocation managed by transarticular screw fixation. OBJECTIVES: To present a case with initial failed wire fixation but successful reduction and fixation with transarticular screw fixation and occipitocervical plate stabilization. SUMMARY OF BACKGROUND DATA: Atlanto-occipital dislocation is generally a fatal injury, except when it occurs in children. Management of this injury is difficult because of multidirectional instability and the problems associated with technical stabilization. METHODS: Intraoperative atlanto-occipital reduction was achieved and maintained by direct C0-C1 transarticular screw fixation. To protect this fixation, a posterior occipitocervical fusion at C0-C2 using a Y-plate was performed. RESULTS: The internal fixation and reduction were maintained, indicating a good surgical outcome, at examination 2 years after surgery. The initially severe neurologic deficit was reduced to some motor weakness of the right hand and weakness of oculomotor function. CONCLUSIONS: Anatomic reduction and reliable fixation with transarticular screws may provide satisfactory clinical results with important neurologic recovery in cases of atlanto-occipital dislocation.