Repeated Complication Following Atlantoaxial Fusion: A Case Report

Repeated Complication Following Atlantoaxial Fusion: A Case Report
윤승환; 현동근; 박형천
Atlantoaxial fusion, Cervical spine, Transpedicle screw, Pedicle screw fracture, Bone fusion, Complication
Issue Date
Series/Report no.
대한척추신경외과학회지; 11권 1호 pp 7~11
Various pathological conditions such as os odontoideum, rotatorysubluxation, dens fracture or trauma, rheumatoid arthritis, and congenital or acquired ligamentous instability can affect the atlantoaxial instability1). Various techniques of atlantoaxial stabilisation have been described in the literature. Gallie reported atlantoaxial arthrodesis by posterior wiring and autologous grafting9), and Magerl and Seeman introduced the C1-C2 transarticular screw fixation16). However, this technique is technically demanding and requires precise radiological and intraoperative knowledge of the localization of the vertebral artery to minimize the risk of iatrogenic damage. Goel et al. described the C1 lateral mass screws/C2 pedicle screws and plates technique11). They reported that the procedure is technically demanding and that anexact three-dimensional understanding of the anatomy of the region and of the vertebral artery is important. Modern atlantoaxial instrumentation techniques are transpedicle screws and screw-rod constructs which is modified by Harms and Melcher17,21). In contrast to the relatively high rate of nonunion with wiring techniques, the rates of successful fusion with modern instrumentation and techniques exceed 95%5). Biomechanical studies showed a construct stability of screw-rod constructs similar to transarticular screws8,14). So, some authors suggested that spine surgeons should reconsidered the use of bracing for C1-2 fusion procedures where rigid segmental fixation has been achieved4). Although they concluded the external cervical orthoses may be not necessary with Class III evidence4), cervical collars were effective to provide an optimal environment for bone fusion by restrict the range of neck movement. Herein, this article reported a two-times unlucky case of pedicle screws fracture after atlantoaixial fusion with several episode of neck hyperflexion, and emphasized the limitation of neck movement after cervical posterior fixation.
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