Objectives: Atlantoaxial dislocation remains a rare and serious condition with a high preoperative and postoperative morbidity and mortality. Its successful surgical management is still challenging and gratifying for neurosurgeons. Several technics have been described such as wiring, trans articular screwing, C1C2 screwing with plate and screw introduced by Goel et al., and modified by insertion of polyaxially screw and rod many years later by Harms. Unavailability and expensiveness of upper cervical spine instrumentation device led us to C1C2 Wiring resulting in a good outcome. Finally, a quadriplegic patient with a more comfortable financial condition had ordered devices from abroad and benefit for Goel and Harms screwing technique and improved dramatically from ASIA A to ASIA E. Materialandmethods: This is a retrospective study of patients managed in our department by a same neurosurgeon from January 2019 to April 2024. Results: We defined 6 men and 1 woman with an average age of 33 years. Unrestrained driver in a rollover motor vehicle accident was most common. Only one patient was neurologically intact on admission. Neurovegetative disorders were noticed in one patient. Dislocation was associated to a fracture of the dens in two patients. Three patients have been successfully operated with remarkable outcome, mostly from ASIA A to E. Conclusion: C1C2 dislocation is a serious condition and C1C2 Wiring represents an effective and cheaper technic. Therefore, this technic should deserve consideration above all in low incomes countries when screwing devices are not available. Seatbelt should be demanded for motor vehicle drivers and passengers.
References
[1]
Lopez, A.J., Scheer, J.K., Leibl, K.E., Smith, A.Z., Dlouhy, B.J. and Dahdaleh, N.S. (2015) Anatomy and Biomechanics of Craniovertebral Junction. Neurosurgical Focus, 38, E2. https://doi.org/10.3171/2015.1.FOCUS14807
[2]
Dao, I., Sanou, A., Alzouma, H., Bako, F., Hema, Y., Zabsonré, S.D. and Kabré, A. (2023) Far Lateral Approach: “Trans-Tumor Approach” on Huge Dumbbell-Shape Neurofibroma of Anterior Foramen Magnum without Craniectomy-Anatomical Consideration and New Trend. Acta Neurochirurgica Supplement, 135, 125-130. https://doi.org/10.1007/978-3-031-36084-8_21
[3]
Goel, A. (2013) Expert’s Comment Concerning Grand Rounds Case Entitled “Treatment Strategies for Severe C1C2 Luxation due to Congenital Os Odontoideum Causing Tetraplegia” (by C. M. Bach, D. Arbab and M. Thaler, doi:10.1007/s00586-012-2329-5). European Spine Journal, 22, 36-38. https://doi.org/10.1007/s00586-012-2549-8
[4]
Alves, O.L., Periera, L., Kim, S.H., Grin, A., Shimokawa, N., Konovalov, N. and Zileli, M. (2020) Upper Cervical Spine Trauma: WFNS Spine Committee Recommendations. Neurospine, 17, 723-736. https://doi.org/10.14245/ns.2040226.113
[5]
Mummaneni, P.V. and Haid, R.W. (2005) Atlantoaxial Fixation: Overview of All Techniques. Neurology India, 53, 408-415. https://doi.org/10.4103/0028-3886.22606
[6]
Goel, A. and Laheri, V. (1994) Plate and Screw Fixation for Atlanto-Axial Subluxation. Acta Neurochirurgica, 129, 47-53. https://doi.org/10.1007/BF01400872
[7]
Sibhi, G. and Lingaraju, T. (2019) Atlanto-Axial Instability and Its Management. Advance Research Journal of Multidisciplinary Discoveries, 39, 1-18.
[8]
Tan, M.S., Gong, L., Yi, P., Yang, F., Tang, X.S., Ma, H.N. and Hao, Q.Y. (2020) New Classification and Its Value Evaluation for Atlantoaxial Dislocation. Orthopaedic Surgery, 12, 1199-1204. https://doi.org/10.1111/os.12734
[9]
Alker Jr., G.J., Oh, Y.S. and Leslie, E.V. (1978) High Cervical Spine and Craniocervical Junction Injuries in Fatal Traffic Accidents: A Radiological Study. Orthopedic Clinics of North America, 9, 1003-1010. https://doi.org/10.1016/S0030-5898(20)32210-0
[10]
Lemus, M.C., Uribe, E.V. AND Avila, J.M.J. (2015) Traumatic Atlantoaxial Subluxation, Posterior Transfacet Fixation: A Case Report. Coluna/Columna, 14, 53-55. https://doi.org/10.1590/S1808-1851201514010R129
[11]
Yin, Q.S. and Wang, J.H. (2015) Current Trends in Management of Atlantoaxial Dislocation. Orthopaedic Surgery, 7, 189-199. https://doi.org/10.1111/os.12196
[12]
Fielding, J.W. and Hawkins, R.J. (1977) Atlanto-Axial Rotatory Fixation. Fixed Rotatory Subluxation of the Atlanto-Axial Joint. The Journal of Bone & Joint Surgery, 59, 37-44. https://doi.org/10.2106/00004623-197759010-00005
[13]
Yang, Y.S., Boniello, A., Poorman, C.E., Chang, A.L., Wang, S. and Passias, P.G. (2014) A Review of Diagnosis and Treatment of Atlantoaxial Dislocations. Global Spine Journal, 4, 197-210. https://doi.org/10.1055/s-0034-1376371
[14]
Passias, P.G., Wang, S., Kozanek, M., Wang, S. and Wang, C. (2013) Relationship between the Alignment of the Occipitoaxial and Subaxial Cervical Spine in Patients with Congenital Atlantoxial Dislocations. Journal of Spinal Disorders and Techniques, 26, 15-21. https://doi.org/10.1097/BSD.0b013e31823097f9
[15]
Fielding, J.W., Hawkins, R.J. and Ratzan, S.A. (1976) Spine Fusion for Atlanto-Axial Instability. The Journal of Bone & Joint Surgery, 58, 400-407. https://doi.org/10.2106/00004623-197658030-00020
[16]
Greenberg, A.D. (1968) Atlanto-Axial Dislocations. Brain, 91, 655-684. https://doi.org/10.1093/brain/91.4.655
[17]
Wang, S.W. (2012) A Novel Surgical Classification and Treatment Strategy for Atlantoaxial Dislocations Based on 1106 Cases Over 14 Years. Cervical Spine Research Society, Chicago.
[18]
Visocchi, M., Signorelli, F., Parrilla, C., Paludetti, G. and Rigante, M. (2021) Multidiscilplinary Approach to the Craniovertebral Junction. Historical Insights, Current and Future Perspectives in the Neurosurgical and Otorhinolaryngological Alliance. ACTA Otorhinolaryngologica Italica, 41, S51-S58. https://doi.org/10.14639/0392-100X-suppl.1-41-2021-05
[19]
Chen, Q., Brahimaj, B.C., Khanna, R., Kerolus, M.G., Tan, L.A., David, B.T. and Fessler, R.G. (2020) Posterior Atlantoaxial Fusion: A Comprehensive Review of Surgical Techniques and Relevant Vascular. Journal of Spine Surgery, 6, 164-180. https://doi.org/10.21037/jss.2020.03.05
[20]
Visocchi, M., Fernandez, E., Ciampini, A. and Di Rocco, C. (2009) Reducible and Irreducible Os Odontoideum in Childhood Treated with Posterior Wiring, Instrumentation and Fusion. Past or Present. Acta Neurochirurgica, 151, 1265-1274. https://doi.org/10.1007/s00701-009-0277-6
[21]
Bailey, D. (1952) The Normal Cervical Spine in Infants and Children. Radiology, 69, 712-719. https://doi.org/10.1148/59.5.712
[22]
Dickman, C.A. (1998) Occipitocervical Wiring Techniques in Surgery of the Craniovertebral Junction. Thieme, New York, 795-808.
[23]
Gluf, W.M. and Brockmeyer, D.L. (2005) Atlantoaxial Transarticular Screw Fixation: A Review of Surgical Indications, Fusion Rate, Complications and Lessons Learned in 67 Paediatric Patients. Journal of Neurosurgery: Spine, 2, 164-169. https://doi.org/10.3171/spi.2005.2.2.0164
[24]
Grob, D., Dvorak, J., Panjabi, M.M. and Antinnes, J.A. (1994) The Role of Plate and Screw Fixation in Occipitocervical Fusion in Rheumatoid Arthritis. Spine, 15, 2545-2551. https://doi.org/10.1097/00007632-199411001-00009
[25]
Menezes, A.H. (1994) Occipito-Cervical Fusion: Indications, Technique and Avoidance of Complications. In: Hitchon, P.W., Ed., Techniques of Spinal Fusion and Stabilisation, Thieme, New York, 82-91.
[26]
Cahill, D. (2000) Posterior Occipital Reconstruction Using Cervical Pedicle Screw and Plate-Rod System. Spine, 24, 1425. https://doi.org/10.1097/00007632-199907150-00007
[27]
Grob, D., Janneret, B. and Aebi, M. (1991) Atlantoaxial Fusion with Transarticular Screw Fixation. The Bone & Joint Journal, 73, 972-976. https://doi.org/10.1302/0301-620X.73B6.1955447
[28]
Magerl, F. and Seman, P.S. (1987) Stable Posterior Fusion of the Atlas and Axis by Transarticular Screw Fixation. In: Kehr, P., Ed., Cervical Spine, Springer, New York, 322-327. https://doi.org/10.1007/978-3-7091-8882-8_59
[29]
Marcotte, P., Dickman, C.A. and Sonntag, V.H.K. (1993) Posterior Atlantoaxial Facet Screw Fixation. Journal of Neurosurgery, 79, 234-237. https://doi.org/10.3171/jns.1993.79.2.0234
[30]
Abboud, H., Ziani, I., Melhaoui, A., Arkha, Y. and Elouahabi, A. (2020) Traumatatic Spine Injury: Short-and Medium-Term Prognostic Factors in 102 Patients. Surgical Neurology International, 11, 19. https://doi.org/10.25259/SNI_593_2019
[31]
Visocchi, M., Di Rocco, F. and Meglio, M. (2003) Craniocervical Junction Instability: Instrumentation Anfusion with Titanium Rods and Sublaminar Wires. Effectiveness and Failures in Personal Experience. Acta Neurochirurgica, 145, 265-272. https://doi.org/10.1007/s00701-002-1067-6
[32]
Visocchi, M., Signorelli, F., Olivi, A. and Caldarelli, M. (2019) Wiring or Screw at the Craniovertebral Junction in Childhood: Past and Present Personal Experience. Acta Neurochirurgica Supplement, 125, 253-258. https://doi.org/10.1007/978-3-319-62515-7_36
