One-Step Reduction and Fixation Applying Transposterior Arch Lateral Mass Screw of C1 Combined With Pedicle Screw of C2 and Rod System for Pediatric Acute Atlantoaxial Rotatory Subluxation With Injury of Transverse Ligament

Study Design. A retrospective case series. Objective. To describe a novel intraoperative reduction technique applying C1 transposterior arch lateral mass screw combined with C2 pedicle screw and rod system for pediatric acute atlantoaxial rotatory subluxation with injury of transverse ligament and evaluate outcomes of this technique. Summary of Background Data. For atlantoaxial rotatory subluxation with disruption of transverse ligament or recurrent cases, initial posterior atlantoaxial fusion is a preference. It is an important prerequisite for successful surgery to achieve satisfactory reduction of atlantoaxial articulation after preoperative cranial traction. However, the placement of cranial tractor and persistent traction may be challenging due to a pediatric patient's noncompliance and unsuitable anatomic structure. Therefore, an intraoperative way to achieve reduction and to keep solid stability with only a single procedure is needed. Methods. The consecutive patients with atlantoaxial rotatory subluxation with injury of transverse ligament, including 4 males and 1 female, underwent intraoperative reduction and fixation applying C1 posterior arch lateral mass screw combined with C2 pedicle screw and rod system during a 2-year period. The surgical technique and procedure of treatment were intensively reviewed; the clinical outcomes were retrospectively investigated in the aspects of clinical symptoms and imaging appearance. Results. Clinical follow-ups were obtained for an average of 29.4 (range, 24-30 mo) months. The clinical and radiological follow-up indicated a complete clinical relief and satisfactory reduction, stable arthrodesis of atlantoaxial articulation. No neural and vascular impairment related to this technique were observed. Conclusion. The primary outcome showed under sufficient preoperative imaging measurements, C1 transposterior arch lateral mass screw combined with C2 pedicle screw and rod system that obviated preoperative cranial traction provided reliable reduction and stability of atlantoaxial articulation for atlantoaxial rotatory subluxation with injury of transverse ligament.