A new technique for reduction of atlantoaxial subluxation using a simple tool during posterior segmental screw fixation

Suh, Bongwon; Padua, Mary Ruth Alfonso; Riew, K. Daniel; Kim, Ho-Joong; Chang, Bong Soon; Lee, Choon-Ki; Yeom, Jin S.

doi:10.3171/2013.5.spine12859

Cited by 23 publications

(21 citation statements)

References 17 publications

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“…A wider osteotome is likely to cause excessive distraction, stretching the V 3 segment beyond physiological limits and indirectly injuring the VA. The reduction in the anteroposterior plane can be achieved by the technique described by Suh et al 10 The rod holder securing the rod in a perpendicular plane acts as a T-shaped lever.…”

Section: Discussionmentioning

confidence: 99%

Direct posterior reduction in a case of posttraumatic irreducible lateral atlantoaxial dislocation

Salunke¹,

Sahoo²,

Doddamani³

et al. 2014

SPI

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T raumaTic atlantoaxial (C1-2) dislocation with Type II odontoid fracture is not uncommon. This usually occurs in the anteroposterior or sagittal plane. However, rotational and lateral C1-2 dislocation is rare. 5,9 The C1-2 facets may get locked, making the dislocation irreducible. We describe a rare case of irreducible C1-2 posterior and true lateral dislocation that was managed successfully by a direct posterior approach. The mode of injury and the method used to achieve intraoperative reduction are discussed. Case ReportHistory and Examination. This 34-year-old man sustained injury in a motor vehicle accident. His face got compressed against the left windowpane due to sudden deceleration, giving rise to distraction and lateral extension of the spine. After a brief period of blackout, he got up and walked around. Apart from mild neck pain he had no other complaints. He did not seek any medical help immediately following injury, because his only symptom of neck pain was not significant. However, 4 weeks later his neck pain worsened and he experienced restricted neck movements. Neurological examination revealed no deficits.A lateral radiograph of the cervical spine showed Type II odontoid fracture with posterior C1-2 dislocation. Admission CT scans of the craniovertebral junction (CVJ) showed true right lateral C1-2 dislocation and locked facets with odontoid fracture (Fig. 1). The fracture line at odontoid base and facets showed no malunion. Skull traction was applied but failed to reduce the dislocation. Besides, the patient's neck pain worsened with skull traction. Because the transverse foramina appeared intact and there were no congenital bone anomalies, we assumed that the vertebral arteries (VAs) were normal, with the redundant V 3 segment compensating for the lateral stretch. We were fortunate not to have any vascular complications. Nevertheless, a preoperative CT angiogram would have been preferable. Posttraumatic true irreducible C1-2 lateral dislocation is rare. The mechanism of injury is likely to be different for this kind of dislocation. The management of such an injury and the technique for direct posterior reduction remain unclear because of its rarity. The authors describe the case of a 34-year-old man who sustained injury in a vehicular accident, leading to neck pain. Radiological studies revealed fixed right lateral and posterior C1-2 dislocation. Direct posterior open reduction was achieved by distracting the facets and rotating them in a counterclockwise direction. Care was taken to avoid direct or indirect injury to the vertebral arteries. Segmental C1-2 fusion was performed. Distraction with lateral extension injury possibly gives rise to this unique fracture dislocation. Preoperative imaging including angiography for vertebral arteries helps in defining the cause of fixity and in surgical planning. Direct posterior reduction is possible in such fixed C1-2 lateral dislocation, circumventing transoral surgery-provided the facets are preserved.

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Section: Discussionmentioning

confidence: 99%

Direct posterior reduction in a case of posttraumatic irreducible lateral atlantoaxial dislocation

Salunke¹,

Sahoo²,

Doddamani³

et al. 2014

SPI

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“…Correction of all the components of dislocation and fixation in realigned position is desirable. In the recent past, techniques have been described by Suh et al and Yin et al that deal with realignment of irreducible C1-2 dislocation by posteriorly releasing the facets and then manipulating them [6,7]. We have devised our own method by modifying and combining the above techniques, to correct the lateral tilt and rotational component apart from correction of vertical and the antero-posterior dislocation in a simple yet effective manner.…”

Section: Introductionmentioning

confidence: 95%

“…Often these dislocations are irreducible and may have additional non-correctable rotational and lateral components. The recent trend has shifted from traditional transoral decompression and posterior fusion to a direct posterior release of facets and reduction of dislocation [2][3][4][5][6][7][8]. Correction of all the components of dislocation and fixation in realigned position is desirable.…”

Section: Introductionmentioning

confidence: 98%

Technique for direct posterior reduction in irreducible atlantoaxial dislocation: Multi-planar realignment of C1–2

Salunke

Sahoo

Khandelwal

et al. 2015

Clinical Neurology and Neurosurgery

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“…The posterior aspect of the C-1 inferior and the C-2 superior articular processes worked as a fulcrum during the reduction procedure, leading to distraction of the anterior soft tissues. In addition, whereas Goel et al first tightened axial screws and then tightened the atlantal screws using plate-and-screw constructs to obtain reduction, we obtained reduction by pulling the C-1 screw heads posteriorly and pushing the C-2 screw heads anteriorly, similar to the technique described by Suh et al 16 These maneuvers were repeated alternately on each side until acceptable reduction was achieved, which can be attained with polyaxial screw-rod systems but not with plate-andscrew systems.…”

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confidence: 99%

Indirect decompression for a prior severe C1–2 dislocation causing progressive quadriparesis

Kim¹,

Lee

Kim

et al. 2014

SPI

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Combined anterior and posterior surgery is frequently chosen for the treatment of prior, severe C1-2 dislocations that occurred during early childhood because of the difficulty in achieving reduction and satisfactory decompression. The authors treated a prior, severe C1-2 dislocation that was causing progressive quadriparesis. The patient was a 14-year-old boy who had suffered a C1-2 fracture-dislocation at 3 years of age and had been treated with a Minerva body jacket cast. The treatment involved posterior C1-2 segmental screw fixation, without direct bone decompression or additional surgery. Satisfactory neural decompression was achieved with the techniques used, and complete bone union was confirmed. The patient showed satisfactory neurological recovery at the 5-year follow-up assessment.

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A new technique for reduction of atlantoaxial subluxation using a simple tool during posterior segmental screw fixation

Cited by 23 publications

References 17 publications

Direct posterior reduction in a case of posttraumatic irreducible lateral atlantoaxial dislocation

Direct posterior reduction in a case of posttraumatic irreducible lateral atlantoaxial dislocation

Technique for direct posterior reduction in irreducible atlantoaxial dislocation: Multi-planar realignment of C1–2

Indirect decompression for a prior severe C1–2 dislocation causing progressive quadriparesis

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