Go Kato1, Kenichi Kawaguchi2, Nobuaki Tsukamoto3, Keisuke Komiyama3, Kazutaka Mizuta4, Takayuki Onohara5, Hirofumi Okano6, Shunsuke Hotokezaka4, Takao Mae3. 1. Department of Spine Surgery, Saga-Ken Medical Centre Koseikan, 400 Nakabaru, Kase-machi, Saga 840-8571, Japan; Department of Trauma Centre, Saga-Ken Medical Centre Koseikan, 400 Nakabaru, Kase-machi, Saga, 840-8571, Japan. Electronic address: gkato23@yahoo.co.jp. 2. Department of Spine Surgery, Saga-Ken Medical Centre Koseikan, 400 Nakabaru, Kase-machi, Saga 840-8571, Japan. 3. Department of Trauma Centre, Saga-Ken Medical Centre Koseikan, 400 Nakabaru, Kase-machi, Saga, 840-8571, Japan; Department of Orthopaedic Surgery, Saga-Ken Medical Centre Koseikan, 400 Nakabaru, Kase-machi, Saga, 840-8571, Japan. 4. Department of Orthopaedic Surgery, Saga-Ken Medical Centre Koseikan, 400 Nakabaru, Kase-machi, Saga, 840-8571, Japan. 5. Department of Emergency Medicine, Saga-Ken Medical Centre Koseikan, 400 Nakabaru, Kase-machi, Saga, 840-8571, Japan. 6. Department of Orthopaedic Surgery, Kumamoto Red Cross Hospital, 2-1-1 Reinan, Higashi-ku, 861-8039, Kumamoto, Japan.
Abstract
BACKGROUND CONTEXT: Halo fixation is now universally performed in the initial reduction and fixation of unstable upper cervical spine injuries; however, persistent high instability and recurrent dislocations of the atlantooccipital and atlantoaxial joints after fixation are not well recognized. PURPOSE: The aim was to describe persistent instability of traumatic dislocations of the atlantooccipital and atlantoaxial joints after halo fixation and a useful method for preventing instability. STUDY DESIGN: This was a case report of a patient who survived traumatic dislocations of the atlantooccipital and atlantoaxial joints. PATIENT SAMPLE: A 73-year-old woman diagnosed with dislocations of the atlantooccipital and atlantoaxial joints along with multiple other injuries sustained in a traffic accident was included. METHODS: After initial closed reduction and halo fixation, congruity of the atlantooccipital and atlantoaxial joints was evaluated using, condylar gap, atlantodental interval, and flexion angulation of C1-C2 after the initial examination and before surgery. RESULTS: Changes in parameters 12 hours after halo fixation revealed re-dislocations and instability of the joints. Backrest elevation with halo fixation tended to reduce re-dislocations. Therefore, we carefully increased the backrest angle and measured the parameters at several angles of elevation within a range that did not affect vital signs to observe the effectiveness of elevation against re-dislocations. Elevation changed the parameters in an elevation angle-dependent manner, and these changes suggested that elevation was effective for reducing re-dislocation of both the atlantooccipital and atlantoaxial joints during halo fixation. With no major complications, this method enabled us to maintain good congruity of the joints for approximately 2 weeks until posterior spinal fusion with internal fixation. CONCLUSIONS: Backrest elevation with halo fixation appears safe to be performed without any other devices and is beneficial for blocking re-dislocation of both the atlantooccipital and atlantoaxial joints as well as possible secondary damage to the upper cervical spinal cord during the external fixation period.
BACKGROUND CONTEXT: Halo fixation is now universally performed in the initial reduction and fixation of unstable upper cervical spine injuries; however, persistent high instability and recurrent dislocations of the atlantooccipital and atlantoaxial joints after fixation are not well recognized. PURPOSE: The aim was to describe persistent instability of traumatic dislocations of the atlantooccipital and atlantoaxial joints after halo fixation and a useful method for preventing instability. STUDY DESIGN: This was a case report of a patient who survived traumatic dislocations of the atlantooccipital and atlantoaxial joints. PATIENT SAMPLE: A 73-year-old woman diagnosed with dislocations of the atlantooccipital and atlantoaxial joints along with multiple other injuries sustained in a traffic accident was included. METHODS: After initial closed reduction and halo fixation, congruity of the atlantooccipital and atlantoaxial joints was evaluated using, condylar gap, atlantodental interval, and flexion angulation of C1-C2 after the initial examination and before surgery. RESULTS: Changes in parameters 12 hours after halo fixation revealed re-dislocations and instability of the joints. Backrest elevation with halo fixation tended to reduce re-dislocations. Therefore, we carefully increased the backrest angle and measured the parameters at several angles of elevation within a range that did not affect vital signs to observe the effectiveness of elevation against re-dislocations. Elevation changed the parameters in an elevation angle-dependent manner, and these changes suggested that elevation was effective for reducing re-dislocation of both the atlantooccipital and atlantoaxial joints during halo fixation. With no major complications, this method enabled us to maintain good congruity of the joints for approximately 2 weeks until posterior spinal fusion with internal fixation. CONCLUSIONS: Backrest elevation with halo fixation appears safe to be performed without any other devices and is beneficial for blocking re-dislocation of both the atlantooccipital and atlantoaxial joints as well as possible secondary damage to the upper cervical spinal cord during the external fixation period.
Authors: Shiyao Liao; Niko R E Schneider; Petra Hüttlin; Paul A Grützner; Frank Weilbacher; Stefan Matschke; Erik Popp; Michael Kreinest Journal: PLoS One Date: 2018-04-06 Impact factor: 3.240