title: Anterior and posterior fixation for delayed treatment of posterior atlantoaxial dislocation without fracture.
abstract: Posterior atlantoaxial dislocation (PAAD) without fracture of the odontoid process is a rare injury. Authors have variously reported closed or open reduction, followed by either anterior or posterior fixation, but there is no consensus on best treatment. We present a particularly unstable case of PAAD. Open reduction through a retropharyngeal approach with odontoidectomy was required for reduction. Anterior fixation with transarticular lag screws was required prior to posterior fixation with pedicle screws. Despite non-compliance with postoperative immobilisation, imaging at 20-month follow-up confirmed solid fusion. The patient is pain-free with a good range of movement of the neck and has returned to a manual job. Our case had a greater degree of instability than was previously reported, which necessitated 360° fixation. This is the first reported case of this treatment strategy, which provided a very stable fixation allowing fusion despite early movement and without causing undue stiffness.
authors.affiliation: Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China.
authors.forename: Hai Ming
authors.initials: HM
authors.lastname: Yu
authors.affiliation: Royal National Orthopaedic Hospital, Stanmore, UK.
authors.forename: Karan
authors.initials: K
authors.lastname: Malhotra
authors.affiliation: Royal National Orthopaedic Hospital, Stanmore, UK.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Butler
authors.affiliation: Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China.
authors.forename: Shi Qiang
authors.initials: SQ
authors.lastname: Wu
mesh_terms: D000328:Adult; D001268:Atlanto-Axial Joint / Q000293:injuries / Q000601:surgery*; D001863:Bone Screws; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery*; D008297:Male; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013124:Spinal Injuries / Q000601:surgery*; D061665:Time-to-Treatment