Surgical treatment for chronic atlantoaxial rotatory fixation in children

Abstract

Six consecutive pediatric patients with chronic atlantoaxial rotatory fixation (AARF) underwent posterior fixation. All patients were first treated conservatively such as with a neck collar, traction, Minerva jacket, or halo-vest; however, they failed to achieve successful reduction because of the C2 facet deformity or C1-2 facet fusion. We performed C1-2 fusion using a C1 lateral mass screw and a C2 pedicle screw, a C1-2 transarticular screw, or an occipitocervical fusion using a rod and wiring system. Five patients achieved solid fusion with no torticollis or neck pain by the final follow-up. One patient had mild torticollis after surgery but no pain. Although we believe that with early diagnosis of AARF and appropriate conservative treatment we can avoid surgery, even with conservative treatment from the onset of symptoms, five patients in our series required surgery because conservative treatment did not lead to successful reduction. When conservative treatment for chronic AARF patients fails, C1-2 transarticular fixation, and C1 lateral mass screw and C2 pedicle screw fixation are reliable methods to treat these patients.

Spinal instrumentation in infants, children, and adolescents: a review

“…39,45,52,93 The use of this technique has been infrequently described in the pediatric spine. 52, 94,109,145 Because of the prohibitive technical and anatomical requirements for the Magerl technique, C1-2 transarticular screws have given way to C1-2 screw-plate or screw-rod constructs as described by Goel and Laheri, 53,55 and Harms and Melcher, 57 respectively. The Goel/Harms technique for C1-2 posterior instrumented fusion may be more applicable even in the smallest of children or those with anatomical variants (Fig.…”

A Review of the Diagnosis and Treatment of Atlantoaxial Dislocations

“…In young adults, fusion is recommended when moderate displacement is seen in flexion and extension cervical radiographs or instability with or without pain is present. 51,60,66,67 In patients with rheumatoid arthritis, surgery should be considered promptly in an asymptomatic patient with atlantoaxial dislocation for any of the following: chronic neck pain in the setting of radiographic instability that does not respond to nonnarcotic pain medication, any degree of atlantoaxial impaction or cord stenosis seen radiographically, the space available for the spinal cord less than or equal to 14 mm, atlantoaxial impaction represented by odontoid migration less than or equal to 5 mm rostral to McGregor line, sagittal canal diameter < 14 mm, or cervicomedullary angle < 135 degrees. 30 For patients with Down syndrome or os odontoideum, there is no clear surgical indication in the literature, but it is recommended to monitor with annual lateral and flexion/extension cervical radiograph due to the possibility of sudden change from spinal cord compression in this patient population.…”

“…In young adults, fusion is recommended when moderate displacement is seen in flexion and extension cervical radiographs or instability with or without pain is present. 51 , 60 , 66 , 67…”

Fusion Surgery Required for Recurrent Pediatric Atlantoaxial Rotatory Fixation after Failure of Temporary Fixation with Instrumentation

“…Atlantoaxial arthrodesis is associated with several problems such as pseudarthrosis, long operation time, and loss of range of motion (ROM) at the atlantoaxial joint. Han et al reported a case series in 13 patients with type 2 odontoid fractures, using temporary pedicle screw fixation without bone fusion for motion preservation [ 14 ]. Ni et al also reported posterior reduction and temporary fixation with odontoid fracture in 22 consecutive patients, and fracture healing was obtained in 21 [ 15 ].…”