Traumatic atlanto-occipital dislocation: presentation of a new posterior occipitoatlantoaxial fixation technique in an adult survivor: technical case report

Abstract

Objective and importance: More survivors of traumatic atlanto-occipital dislocation (AOD) in adults have recently been reported. Surgical management options are therefore of increasing interest. We present a new technique of posterior C0-C1-C2 fixation.

Clinical presentation: A 29-year-old motorcyclist survived a traumatic vertical AOD of 15 mm. No spinal cord or medullary lesion was present. Brain contusion and diffuse axonal injuries led to a cortical biplegia, which recovered progressively over a period of 6 months. Twelve months after surgery, no neurological deficit was present except for slightly increased deep tendon reflexes.

Intervention: Posterior C0-C1-C2 fixation was performed with two bicortical occipital screws, one bicortical lateral mass screw in the atlas, and one monocortical pars screw in the axis on each side, connected to a plate-rod on the right and left sides. Fusion was performed with monocortical bone graft from the posterior iliac crest.

Conclusion: The surgical technique described was thought to be safe to perform and resulted in immediate stability without external immobilization. Solid fusion was achieved 6 months after surgery.