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Published on: October 5, 2009

Occipitocervical fusion in an infant with atlantooccipital dislocation

Edward C Benzel1, Donald H Zhang, Christopher Iannotti

  • 1Center for Spine Health, Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, USA. benzele@ccf.org

World Neurosurgery
|March 3, 2012
PubMed

Insights

Surgical stabilization of atlantooccipital dislocation (AOD) in infants is challenging. This case report details a successful occipitocervical fusion using bone morphogenic protein 2 (BMP-2) and autologous rib in an infant with type I AOD.

Area of Science:

  • Pediatric Neurosurgery
  • Orthopedic Surgery
  • Trauma Surgery

Background:

  • Atlantooccipital dislocation (AOD) in infants presents unique surgical challenges due to the complex anatomy of the occipitocervical junction.
  • Early surgical stabilization and arthrodesis are crucial for surviving children with traumatic AOD.
  • Creating a safe and biomechanically sound fusion construct in infants with AOD is particularly difficult.

Observation:

  • A 12-month-old female infant with type I AOD and gross instability resulting from a motor vehicle accident underwent surgical stabilization.
  • The procedure involved occiput to C2 arthrodesis using autologous rib, augmented with bone morphogenic protein 2 (BMP-2), Mersilene, and Ethibond sutures.
  • No intraoperative complications occurred during the stabilization procedure.

Findings:

  • Postoperative cervical spine CT at 12 weeks showed excellent occipitocervical alignment and evidence of bony fusion from the occiput to C2.
  • Neurological examination revealed progressive improvement, including partial resolution of sixth nerve palsies and enhanced muscle strength and tone.

Implications:

  • This case demonstrates the successful application of BMP-2-augmented occipitocervical fusion in an infant with severe AOD and instability.
  • The described technique using autologous rib, BMP-2, and specific sutures offers a viable solution for complex pediatric occipitocervical fusion.
  • This approach may improve outcomes for infants suffering from traumatic atlantooccipital dislocation.
Abstract

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