title: [Transoral atlanto-axial plate fixation in the treatment of a malunited dens fracture and secondary atlanto-axial instability].
abstract: BACKGROUND
  A case of a 22-year-old patient with a malunited dens fracture and secondary atlanto-axial instability is presented. The significant narrowing of the spinal canal due to the atlanto-axial instability was associated with anterior myelon compression and neurological deficit.
  
  
  METHODS
  A transoral approach with odontoid resection and anterior atlanto-axial plate fixation was performed. With this technique the atlanto-axial subluxation was reduced and the myelon was decompressed.
  
  
  RESULTS
  The postoperative course was uneventful. The follow-up showed a complete remission of the neurological deficit and a bony fusion of the atlanto-axial joints.
  
  
  CONCLUSIONS
  The presented case illustrates the importance of an accurate initial diagnosis of the degree of instability and the need for short-term follow-up examinations. If atlanto-axial pseudarthrosis or malunion with anterior spinal cord compression occurs, a transoral procedure with odontoid resection and atlanto-axial plate fixation seems to be an excellent salvage procedure.
authors.affiliation: Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Charité, Humboldt-Universität zu Berlin. cyrus.khodadadyan@charite.de
authors.forename: C
authors.initials: C
authors.lastname: Khodadadyan-Klostermann
authors.forename: F
authors.initials: F
authors.lastname: Kandziora
authors.forename: K J
authors.initials: KJ
authors.lastname: Schnake
authors.forename: N P
authors.initials: NP
authors.lastname: Haas
authors.forename: J
authors.initials: J
authors.lastname: Harms
mesh_terms: D000328:Adult; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D001860:Bone Plates; D005260:Female; D005593:Fracture Fixation, Internal; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery*; D009809:Odontoid Process / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D012086:Reoperation; D013130:Spinal Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed
vernacular_title: Transorale atlanto-axiale Plannenspondylodese in der Behandlung einer fehlverheilten Densfraktur mit sekundärer atlanto-axialer Instabilität.