title: Repeated complication following atlantoaxial fusion: a case report.
abstract: A patients with atlantoaixial instability and osodontoideum underwent atlantoaixial fusion (Harms and Melcher technique) with demineralized bone matrix. But, unfortunately, the both pedicle screws in C2 were fractured within 9 weeks follow-up periods after several suspected episode of neck hyper-flexion. Fractured screws were not contact to occipital bone in several imaging studies, but it could irritate the occipital bone when neck extension because the relatively close distance between the occipital bone and C1 posterior arch. The patient underwent revision operation with translaminar screw fixation with autologus iliac bone graft. Postsurgical course were uneventful except donor site pain, but the bony fusion was not satisfied after 4 months follow-up. The patient re-underwent revision operation in other hospital. Continuous complication after atlantoaixial fusion is rare, but the clinical course could be unlucky to patients. Postoperative immobilization could be important to prevent the unintended clinical course of patients.
authors.affiliation: Department of Neurosurgery, Guro TeunTeun Hospital, Seoul, Korea.
authors.forename: Chang Hyun
authors.initials: CH
authors.lastname: Oh
authors.affiliation: Department of Neurosurgery, Guro TeunTeun Hospital, Seoul, Korea.
authors.forename: Gyu Yeul
authors.initials: GY
authors.lastname: Ji
authors.affiliation: Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea.
authors.forename: Hyun Sung
authors.initials: HS
authors.lastname: Seo
authors.affiliation: Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea.
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Yoon
authors.affiliation: Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea.
authors.forename: Dongkeun
authors.initials: D
authors.lastname: Hyun
authors.affiliation: Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea.
authors.forename: Hyeong-Chun
authors.initials: HC
authors.lastname: Park
keywords: Atlantoaxial fusion; Bone fusion; Cervical spine; Complication; Pedicle screw fracture; Transpedicle screw