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Post-traumatic atlantoaxial rotatory fixation in an adult: a case report
Yeon-Seong Kim1, Jung-Kil Lee, Sung-Jun Moon
1Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Korea.
Study Design:
A case report.
Objective:
To describe an interesting patient who underwent open reduction and C1-C2 transpedicular screw fixation with interspinous wiring due to high-riding vertebral artery.
Summary Of Background Data:
Atlantoaxial rotatory fixation (AARF) is a rare complication found most frequently after trauma in children and young adults; the clinical diagnosis is difficult and often made late.
Methods:
We report a case of post-traumatic AARF associated with a facet fracture in an adult. Reduction proved difficult to obtain by skull traction and gentle manipulation. Therefore, after open reduction under general anesthesia, we performed C1-C2 transpedicular screw fixation with posterior wiring to avoid vertebral artery injury due to high-riding transverse foramen at the C2 vertebra.
Results:
The normal atlantoaxial relation was restored and the torticollis resolved. The patient remains neurologically intact and has radiographic documentation of fusion.
Conclusion:
Although technically demanding, C1-C2 transpedicular screw fixation combined with interspinous bone graft wiring after open reduction may be an alternative treatment option if conservative treatment fails to reduce AARF.
