Transarticular screw fixation for atlanto-occipital dislocation.
METHODS
A case report of traumatic atlanto-occipital dislocation managed by transarticular screw fixation.


OBJECTIVE
To present a case with initial failed wire fixation but successful reduction and fixation with transarticular screw fixation and occipitocervical plate stabilization.


BACKGROUND
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.
Spine Unit, Schulthess Klinik, Zürich, Switzerland. gro@kws.ch
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D001269:Atlanto-Occipital Joint / Q000293:injuries / Q000473:pathology / Q000601:surgery*; D001860:Bone Plates / Q000592:standards; D001863:Bone Screws; D002648:Child; D005260:Female; D020546:Fourth Ventricle / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000473:pathology / Q000601:surgery; D004204:Joint Dislocations / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D020127:Recovery of Function / Q000502:physiology; D013115:Spinal Canal / Q000293:injuries / Q000473:pathology / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D013124:Spinal Injuries / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D013346:Subarachnoid Space / Q000293:injuries / Q000473:pathology / Q000601:surgery; D014143:Traction / Q000009:adverse effects; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000293:injuries / Q000473:pathology / Q000601:surgery*