title: Temporary Internal Fixation Using C1 Lateral Mass Screw and C2 Pedicle Screw (Goel-Harms Technique) without Bone Grafting for Chronic Atlantoaxial Rotatory Fixation.
abstract: BACKGROUND
  The primary treatment strategy for chronic atlantoaxial rotatory fixation (chro-AARF) is traction followed by bracing or application of a halo device. However, to complete these conservative therapies, patient cooperation is mandatory. If conservative therapy fails, surgery is required for reduction and prevention of recurrence. It has been considered that surgery for atlantoaxial rotatory fixation necessitates solid bony fusion. However, once bony fusion is achieved, loss of range of motion is problematic. Here, we report a patient with chro-AARF who was successfully treated with temporary internal fixation using a C1 lateral mass screw and C2 pedicle screw (Goel-Harms technique) without any grafting of bone or use of bone substitute materials.
  
  
  METHODS
  A 9-year-old boy with chro-AARF was referred to our institution. He had a history of pervasive developmental disorders. He did not cooperate for the completion of conservative therapy and could not tolerate this therapy. Therefore, the orthopedic staff and his parents considered surgery. Under general anesthesia, reduction was easily performed. The Goel-Harms screw-rod construct was completed as a temporary internal fixator without any grafting of bone or use of bone substitute materials. After 6 months, the screw-rod construct was removed. Removal of the screw-rod construct was performed easily without complication. There was no ankylosis of the C1-2 joint, and cervical range of motion was maintained 2.8 years after removal of the construct.
  
  
  CONCLUSIONS
  When conservative therapy cannot be continued, Goel-Harms surgery as a temporary internal fixator without bone grafting might be a suitable alternative for selected patients with chro-AARF.
authors.affiliation: Department of Orthopaedic Surgery, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Matsumoto
authors.affiliation: Department of Rehabilitation Medicine, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan. Electronic address: mjun.mac1@mac.com.
authors.forename: Jun
authors.initials: J
authors.lastname: Mizutani
authors.affiliation: Department of Orthopaedic Surgery, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Suzuki
authors.affiliation: Department of Orthopaedic Surgery, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Otsuka
authors.affiliation: Department of Orthopaedic Surgery, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hayakawa
authors.affiliation: Department of Orthopaedic Surgery, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Muneyoshi
authors.initials: M
authors.lastname: Fukuoka
authors.affiliation: Department of Rehabilitation Medicine, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Ikuo
authors.initials: I
authors.lastname: Wada
mesh_terms: D001268:Atlanto-Axial Joint / Q000601:surgery*; D002648:Child; D002908:Chronic Disease; D006801:Humans; D016268:Internal Fixators; D008297:Male; D019547:Neck Pain / Q000209:etiology; D065289:Pedicle Screws; D016059:Range of Motion, Articular / Q000502:physiology; D013123:Spinal Fusion / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed; D014102:Torsion Abnormality / Q000601:surgery*; D014103:Torticollis / Q000601:surgery*
keywords: Atlantal lateral mass screw; Atlantoaxial rotatory fixation; Bone grafting; Conservative therapy; Goel-Harms technique; Internal fixation; Surgical management