title: Combination of skull traction with posterior C1-2 fusion for old C1-2 dislocations.
abstract: Between January 2003 and December 2009, 23 patients who had suffered old C1-2 dislocations, were surgically treated in our orthopedics department. Fifteen patients underwent direct posterior C1-2 fusion following pre-operative reduction by skull traction. In eight patients, reduction was achieved only by skull traction under general anesthesia, facilitated by manual hyperextension of the cervical spine and maintained by simultaneous posterior C1-2 fusion. Intra-operative traction was monitored using C-arm fluoroscopy and cortical somatosensory-evoked potentials. Posterior C1-2 fixation was achieved in nine patients using C1-2 laminar hooks and in 14 patients using C1 laminar hooks with C2 pedicle screws. During the follow-up of 5 to 72 months (mean: 42.8 months), solid bony fusion was accomplished in all patients. Using Di Lorenzo's grades and Japanese Orthopedics Association scores, there was significant improvement (p<0.05). The cervical medullary angle exhibited a significant improvement of 31.7°, from 121.6° to 153.3° (p<0.05). There were no complications, including dural tears, spinal cord damage, vertebral artery damage, or breakage or loosening of implants.
authors.affiliation: Orthopedics Department, The First Affiliated Hospital of Soochow University, Suzhou 215006, China.
authors.forename: Xue Feng
authors.initials: XF
authors.lastname: Li
authors.forename: Hui Lin
authors.initials: HL
authors.lastname: Yang
authors.forename: Wei Min
authors.initials: WM
authors.lastname: Jiang
authors.forename: Tian Si
authors.initials: TS
authors.lastname: Tang
authors.forename: Xiao Hong
authors.initials: XH
authors.lastname: Gong
authors.forename: Jing
authors.initials: J
authors.lastname: Yuan
authors.forename: Ji Gang
authors.initials: JG
authors.lastname: Zhang
authors.forename: Gen Lin
authors.initials: GL
authors.lastname: Wang
mesh_terms: D000328:Adult; D001268:Atlanto-Axial Joint / Q000601:surgery*; D002574:Cervical Vertebrae / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D014143:Traction / Q000379:methods*