Related Experiment Video
Updated: May 16, 2026
A Teleoperated Robotic System-Assisted Percutaneous Transiliac-Transsacral Screw Fixation Technique
Published on: January 6, 2023
One-step fixation of atlantoaxial rotatory subluxation: technical note and report of three cases
Nader S Dahdaleh1, Brian J Dlouhy, Arnold H Menezes
1Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Objective:
To describe a successful one-step intraoperative reduction of atlantoaxial rotatory subluxation (AARS) using neuromuscular blockade and intraoperative traction.
Methods:
While the patient was undergoing continuous somatosensory evoked potential monitoring, crown halo traction was applied under general anesthesia. A muscle relaxant was administered, and an intraoperative computed tomography scan was performed using the O-arm Surgical Imaging System in the supine position verifying adequate reduction. The patient was placed in the prone position, and a repeat image was obtained verifying persistent reduction in the position that the patient would undergo dorsal fixation. Occipitocervical fixation was then performed.
Results:
This technique was performed successfully in three pediatric patients with chronic AARS. There were no complications related to the procedure.
Conclusions:
Intraoperative traction and neuromuscular blockade achieved a one-step reduction before fixation for subacute and chronic irreducible AARS. This one-step reduction obviates preoperative traction, which is often inconvenient and not tolerated by pediatric patients. Successful reduction is also demonstrated in detail intraoperatively with three-dimensional imaging.
