Dorothea Daentzer1. 1. Orthopedic Department, Hannover Medical School, Clinic II Annastift, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany. daentzer@tiscali.de
Abstract
INTRODUCTION: In case of atlantoaxial instability dorsal C1-C2 screw fixation is the most appropriate procedure to get immediate and sufficient three-point fixation. However, this method cannot be performed in bilateral high-riding vertebral arteries because of high risk of VA injury. CASE DESCRIPTION: In a 66-year-old woman who presented with neck pain due to atlantoaxial instability bilateral high-riding VAs were detected in CT. To avoid VA injury a dorsal stabilization procedure with a hook-rod system and interspinous autologous iliac crest graft was performed. The intra- and postoperative courses had no complications and the hook-rod construction clinically led to immediate postoperative stability. After 24 months the patient was painfree. CONCLUSIONS: In case of atlantoaxial instability and bilateral high-riding VAs dorsal C1-C2 fixation procedure with a hook-rod system and interspinous bone grafting seems to be an appropriate alternative surgical technique and can get immediate and clinically sufficient stability with no risk of VA injury.
INTRODUCTION: In case of atlantoaxial instability dorsal C1-C2 screw fixation is the most appropriate procedure to get immediate and sufficient three-point fixation. However, this method cannot be performed in bilateral high-riding vertebral arteries because of high risk of VA injury. CASE DESCRIPTION: In a 66-year-old woman who presented with neck pain due to atlantoaxial instability bilateral high-riding VAs were detected in CT. To avoid VA injury a dorsal stabilization procedure with a hook-rod system and interspinous autologous iliac crest graft was performed. The intra- and postoperative courses had no complications and the hook-rod construction clinically led to immediate postoperative stability. After 24 months the patient was painfree. CONCLUSIONS: In case of atlantoaxial instability and bilateral high-riding VAs dorsal C1-C2 fixation procedure with a hook-rod system and interspinous bone grafting seems to be an appropriate alternative surgical technique and can get immediate and clinically sufficient stability with no risk of VA injury.