Intraarticular atlantooccipital fusion for the treatment of traumatic occipitocervical dislocation in a child: a new technique for selective stabilization with nine years follow-up.
METHODS
A case report of traumatic atlantooccipital dislocation (AOD) managed by intraarticular-posterior fusion from a posterior approach at the C0-C1 level with preservation of C1-C2 motion.


OBJECTIVE
To present a new technique for atlantooccipital fusion with long-term follow-up.


BACKGROUND
There is an increasing number of patients with AOD who have preservation of neurologic function. The most frequent method used to treat this condition is occipitocervical fusion. There has been a tendency in recent years to minimize the extent of stabilization, performing occipitoatlantal fusion only. However, it is difficult to achieve a solid fusion between C0 and C1, and the long-term effect of the insufficiency of lig. alaria on C0-C2 stability is unknown. The authors present a modified technique of C0-C1 fusion that aims to enhance fusion and achieve greater stability.


METHODS
A 11-year-old child with AOD was initially treated unsuccessfully with a halo device for 3 months. As instability persisted, an isolated C0-C1 fusion was performed from a posterior approach. This anatomically based intraarticular fusion technique comprises removal of the articular cartilage of the atlantooccipital joints, and cancellous bone autografting at the atlantooccipital joints and between the occiput and posterior arch of C1, supported by an occipital plate linked by rods to lateral mass screws in the atlas.


RESULTS
This technique of increased bony fusion surface and internal fixation provided an excellent result with full recovery of minor neurologic deficits. At long-term follow-up, 9 years after surgery, the patient was free of signs and symptoms; solid fusion of the C0-C1 joint, and normal values for rotation of the C1-C2 segment were recorded.


CONCLUSIONS
Intraarticular and posterior fusion of the atlantooccipital joint was able to provide an excellent long-term clinical outcome in the treatment of traumatic AOD in a child. This is the first report of an intraarticular fusion of the C0-C1 segment and the longest follow-up published on isolated C0-C1 stabilization.
Jeszenszky
Dezso
D
Schulthess Clinic, Spine Center, Lengghalde 2, Zürich, Switzerland. dezsoe.jeszenszky@kws.ch
Fekete
Tamás Fülöp
TF
Lattig
Friederike
F
Bognár
László
L
D000063:Accidents, Traffic; D000367:Age Factors; D001269:Atlanto-Occipital Joint / Q000293:injuries* / Q000473:pathology / Q000601:surgery*; D001368:Axis, Cervical Vertebra / Q000293:injuries / Q000473:pathology / Q000601:surgery; D001860:Bone Plates; D001863:Bone Screws; D016025:Bone Transplantation; D001270:Cervical Atlas / Q000293:injuries / Q000473:pathology / Q000601:surgery; D002648:Child; D016267:External Fixators; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008022:Ligaments / Q000293:injuries / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D009777:Occipital Bone / Q000293:injuries / Q000473:pathology / Q000601:surgery; D016059:Range of Motion, Articular / Q000502:physiology; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013124:Spinal Injuries / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult; D021801:Zygapophyseal Joint / Q000293:injuries / Q000473:pathology / Q000601:surgery