[Experience in posterior wiring and fusion in atlanto-axial luxation]

From 1980 to 87, 29 cases, aged 31 years on average range, 10 to 65 years, of atlantoaxial dislocation were treated by posterior wiring and bone grafting. They were brought to us as late as 12 days to 157 months (24.4 months on average) after injury. 19 of them had been suffering from paralysis quadriplegia, Brown Sequard syndrome, pharyngeal nerve palsy etc.) of various degrees. Follow-up study, after an average period of 2.5 years (1 to 6.5 years.) revealed that 21 patients (72.4%) had resumed their previous work or study; 6 patients had been able either to do light work (3; 10.3%) or to take care of themselves in daily life (3; 10.3%); the rest 2 (7%) had died of unrelated illness. On physical examination, the 27 alive patients had restored full neck motion, but lack of less than 30 degrees of rotation in some cases. Roentgenograms showed bony union of graft in every case, anatomical reduction of luxation in 19, and A-D distance remained 1 to 4 mm. in 10. It is obvious that this operative measure is simple, safe and effective. Some hazards encountered in 4 cases during operation but recovered later, are described. Pre and postoperative managements; as well as operative procedures are given in steps; the former are particularly emphasized on account of their roles, very important to success.