Indirect decompression for a prior severe C1-2 dislocation causing progressive quadriparesis.

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Severe C1-2 dislocations in childhood often require combined anterior-posterior surgery due to challenges in reduction and decompression.
• Delayed treatment of such injuries can lead to progressive neurological deficits like quadriparesis.

Observation:

• A 14-year-old male with a history of C1-2 fracture-dislocation at age 3, treated non-operatively with a Minerva cast, presented with progressive quadriparesis.
• The patient underwent posterior C1-2 segmental screw fixation as the sole surgical intervention.

Findings:

• The posterior C1-2 segmental screw fixation successfully achieved adequate neural decompression without requiring direct bone decompression or additional surgical procedures.
• Complete bone union was confirmed post-operatively.
• The patient experienced satisfactory neurological recovery at the 5-year follow-up.

Implications:

• Posterior C1-2 segmental screw fixation represents a viable, less invasive alternative for managing severe, late-presenting C1-2 dislocations in pediatric patients.
• This technique may offer a simpler surgical solution with good long-term outcomes for spinal cord decompression and stabilization.
• Further research could explore the long-term efficacy and potential complications of this approach in a larger cohort.