title: Acute atlanto-axial post-operative subluxation following posterior C1/2 fusion.
abstract: Two cases referred with acute post-operative C1/2 subluxation following posterior fusion are reported. Both cases had initial treatment for atlanto-axial instability with posterior cable (Brooks and interspinous) and graft techniques, and placed immediately in a Philadelphia collar. One case was found to have subluxed immediately post-operatively when failing to breathe following reversal of anaesthetic agents, and despite immediate realignment and reoperation was left with a significant quadriparesis. The other patient was noted to have subluxed on routine X-ray on day 4, and had no neurological deficit before or after reoperation. Risk factors for this dangerous complication are discussed and the techniques of C1/2 posterior fusion and stabilization are reviewed in detail. Surgeons performing atlanto-axial stabilization procedures should be familiar with and have expertize in the complete range of techniques described and choose the one most appropriate for the patient's individual requirements.
authors.affiliation: Department of Neurosurgery, University of Melbourne, The Royal Melbourne Hospital, Parkville, Victoria, Australia. john.laidlaw@mh.org.au
authors.forename: John D
authors.initials: JD
authors.lastname: Laidlaw
authors.forename: Bhadrakant
authors.initials: B
authors.lastname: Kavar
authors.forename: Kevin H
authors.initials: KH
authors.lastname: Siu
mesh_terms: D001268:Atlanto-Axial Joint / Q000601:surgery*; D001863:Bone Screws; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods