title: Traumatic atlanto-occipital dislocation: presentation of a new posterior occipitoatlantoaxial fixation technique in an adult survivor: technical case report.
abstract: OBJECTIVE
  More survivors of traumatic atlanto-occipital dislocation (AOD) in adults have recently been reported. Surgical management options are therefore of increasing interest. We present a new technique of posterior C0-C1-C2 fixation.
  
  
  METHODS
  A 29-year-old motorcyclist survived a traumatic vertical AOD of 15 mm. No spinal cord or medullary lesion was present. Brain contusion and diffuse axonal injuries led to a cortical biplegia, which recovered progressively over a period of 6 months. Twelve months after surgery, no neurological deficit was present except for slightly increased deep tendon reflexes.
  
  
  METHODS
  Posterior C0-C1-C2 fixation was performed with two bicortical occipital screws, one bicortical lateral mass screw in the atlas, and one monocortical pars screw in the axis on each side, connected to a plate-rod on the right and left sides. Fusion was performed with monocortical bone graft from the posterior iliac crest.
  
  
  CONCLUSIONS
  The surgical technique described was thought to be safe to perform and resulted in immediate stability without external immobilization. Solid fusion was achieved 6 months after surgery.
authors.affiliation: Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland. mpayer@hotmail.com
authors.forename: Michael
authors.initials: M
authors.lastname: Payer
authors.forename: Cyrille C
authors.initials: CC
authors.lastname: Sottas
mesh_terms: D000328:Adult; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D001269:Atlanto-Occipital Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011859:Radiography; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging / Q000601:surgery