A Novel Treatment of Pediatric Atlanto-Occipital Dislocation with Nonfusion Using Muscle-Preserving Temporary Internal Fixation of C0-C2: Case Series and Technical Note
2023 (English)In: Journal of Neurological Surgery Reports, ISSN 2193-6358, E-ISSN 2193-6366, Vol. 84, no 1, p. e11-e16Article in journal (Refereed) Published
Abstract [en]
Study Design: Case series with surgical technical note.
Objectives: This article reports experiences and results of muscle-preserving temporary C0-C2 fixation for the treatment of atlanto-occipital dislocation (AOD).
Methods: AOD is a rare injury caused by high-energy trauma, occurring in less than 1% of pediatric trauma patients. Recommended treatment is C0-C2 fusion which, however, will result in significant loss of mobility in the craniocervical junction (CCJ), especially C1-C2 rotation. An alternative approach, with the ability of preserving mobility in the C1-C2 segment, is a temporary fixation that allows the ligaments to heal, after which the implants can be removed to regain function in the CCJ joints. By using a muscle-preserving approach and navigation for the C2 screws, a relatively atraumatic fixation of the CCJ can be achieved with motion recovery after implant removal.
Results: We present two cases of AOD treated with temporary fixation. A 12-year-old boy involved in a frontal car collision, as a strapped back seat passenger, was treated with temporary C0-C2 fixation for 10 months. Follow-up at 11 months after implant removal included clinical evaluation, computed tomography, magnetic resonance imaging (MRI), and flexion-extension X-rays. He was free of symptoms at follow-up. The CCJ was radiographically stable and he had 45 degrees of C1-C2 rotation. A 7-year-old girl was hit by a car as she got off a bus. She was treated with temporary fixation for 4 months after which the implant was removed. Follow-up at 8 years included clinical evaluation and MRI in rotation. She was free of symptoms. The ligaments of the CCJ appeared normal and her C1-C2 rotation was 30 degrees.
Conclusion: C0-C2 fixation without fusion allows the CCJ ligaments to heal in pediatric AOD. By removing the implants after ligament healing, rotation in the C1-C2 segment can be regained without subsequent instability. Both our patients tolerated the treatment well and were free of symptoms at follow-up. By using minimally invasive muscle-preserving technique and navigation, temporary fixation of the CCJ can be achieved with minimal damage to the soft tissues allowing recovery of almost normal function after implant removal.
Place, publisher, year, edition, pages
Thieme Medical Publishers, 2023. Vol. 84, no 1, p. e11-e16
Keywords [en]
Atlanto-occipital dislocation, craniocervical dissociation, motion preservation, muscle preservation, navigation, occipitocervical dissociation
National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:oru:diva-103729DOI: 10.1055/s-0043-1760830ISI: 000922198100001PubMedID: 36703921OAI: oai:DiVA.org:oru-103729DiVA, id: diva2:1732014
2023-01-302023-01-302023-02-20Bibliographically approved