title: Role of the O-arm and Computer-assisted Navigation of Safe Screw Fixation in Children with Traumatic Rotatory Atlantoaxial Subluxation.
abstract: METHODS
  A retrospective analysis of 7 patients with traumatic rotatory atlanto-axial subluxation.
  
  
  BACKGROUND
  Cases of traumatic rotatory atlantoaxial subluxation in children are difficult to be stabilized. Surgical challenges include: narrow pedicles, medial vertebral arteries, vertebral artery anomalies, fractured pedicles or lateral masses, and fixed subluxation. The use of O-arm and computer-assisted navigation are still tested as aiding tools in such operative modalities.
  
  
  OBJECTIVE
  Report of clinical series for evaluation of the safety of use of the O-arm and computed assisted-navigation in screw fixation in children with traumatic rotatory atlantoaxial subluxation.
  
  
  METHODS
  In the present study, 7 cases of rotatory atlantoaxial traumatic subluxation were operated between December 2009 and March 2011. All patient-cases had undergone open reduction and instrumentation using atlas lateral mass and axis pedicle screws with intraoperative O-arm with computer-assisted navigation.
  
  
  RESULTS
  All hardware was safely placed in the planned trajectories in all the 7 cases. Intraoperative O-arm and computer assisted-navigation were useful in securing neural and vascular tissues safety with tough-bony purchases of the hardware from the first and only trial of application with sufficient reduction of the subluxation.
  
  
  CONCLUSIONS
  Successful surgery is possible with using the intraoperative O-arm and computer-assisted navigation in safe and proper placement of difficult atlas lateral mass and axis pedicle screws for rotatory atlantoaxial subluxation in children.
authors.affiliation: Department of Spine Surgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia.
authors.forename: Walid
authors.initials: W
authors.lastname: Attia
authors.forename: Tamer
authors.initials: T
authors.lastname: Orief
authors.forename: Khaled
authors.initials: K
authors.lastname: Almusrea
authors.forename: Mohamed
authors.initials: M
authors.lastname: Alfawareh
authors.forename: Lahbib
authors.initials: L
authors.lastname: Soualmi
authors.forename: Yasser
authors.initials: Y
authors.lastname: Orz
keywords: Atlantoaxial joint fusion; Computer-assisted three-dimensional imaging; Intraoperative computer-assisted 3D navigation