title: A new technique for reduction of atlantoaxial subluxation using a simple tool during posterior segmental screw fixation: clinical article.
abstract: OBJECTIVE
  The authors introduce a simple technique and tool to facilitate reduction of atlantoaxial subluxation during posterior segmental screw fixation.
  
  
  METHODS
  Two types of reduction tool have been designed: T-type and L-type. A T-shaped levering tool was used when a pedicle or pars screw was used for C-2, and an L-shaped tool was used when a laminar screw was used for C-2. Twenty-two patients who underwent atlantoaxial segmental screw fixation and fusion for the treatment of anteroposterior instability or subluxation, using either of these new types of reduction tool, were enrolled. Demographic, clinical, and surgical data, which had been prospectively collected in a database, were analyzed. The atlantodens interval was measured on lateral radiographs, and the space available for the spinal cord was measured on CT scans.
  
  
  RESULTS
  The authors could attain reduction of the atlantoaxial subluxation without difficulty using either type of tool. The preoperative atlantodens interval ranged from -16.9 to 10.9 mm in a neutral position, and the postoperative interval ranged from -2.8 to 3.0 mm, with negative values due to extension-type or mixed-type instability. The mean space available for the spinal cord significantly increased, from 9.5 mm preoperatively to 15.4 mm postoperatively (p < 0.001).
  
  
  CONCLUSIONS
  This technique allowed for controlled manipulation and reduction of the atlantoaxial subluxation without difficulty.
authors.affiliation: Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Sungnam, Korea.
authors.forename: Bo-Gun
authors.initials: BG
authors.lastname: Suh
authors.forename: Mary Ruth A
authors.initials: MR
authors.lastname: Padua
authors.forename: K Daniel
authors.initials: KD
authors.lastname: Riew
authors.forename: Ho-Joong
authors.initials: HJ
authors.lastname: Kim
authors.forename: Bong-Soon
authors.initials: BS
authors.lastname: Chang
authors.forename: Choon-Ki
authors.initials: CK
authors.lastname: Lee
authors.forename: Jin S
authors.initials: JS
authors.lastname: Yeom
mesh_terms: D000328:Adult; D000368:Aged; D001268:Atlanto-Axial Joint / Q000473:pathology / Q000601:surgery*; D001863:Bone Screws / Q000592:standards*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult