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CC BY-NC-ND 4.0 · J Neurol Surg Rep 2023; 84(01): e11-e16
DOI: 10.1055/s-0043-1760830
Case Report

A Novel Treatment of Pediatric Atlanto-Occipital Dislocation with Nonfusion Using Muscle-Preserving Temporary Internal Fixation of C0-C2: Case Series and Technical Note

Marek Holy 
1   Department of Orthopedics, Örebro University Hospital, Örebro University, Örebro, Sweden
,
Lilla Szigethy
2   Department of Orthopedics, Örebro University Hospital, Örebro, Sweden
,
Anders Joelson
1   Department of Orthopedics, Örebro University Hospital, Örebro University, Örebro, Sweden
,
Claes Olerud
3   Department of Surgical Sciences, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
› Author Affiliations Funding Institutional funding: The funder played no part in study design; collection, management, analysis, and interpretation of data; writing of the report; and the decision to submit the report for publication.
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Abstract

Study Design Case series with surgical technical note.

Objectives This article reports experiences and results of muscle-preserving temporary C0-C2 fixation for the treatment of atlanto-occipital dislocation (AOD).

Methods AOD is a rare injury caused by high-energy trauma, occurring in less than 1% of pediatric trauma patients. Recommended treatment is C0-C2 fusion which, however, will result in significant loss of mobility in the craniocervical junction (CCJ), especially C1-C2 rotation. An alternative approach, with the ability of preserving mobility in the C1-C2 segment, is a temporary fixation that allows the ligaments to heal, after which the implants can be removed to regain function in the CCJ joints. By using a muscle-preserving approach and navigation for the C2 screws, a relatively atraumatic fixation of the CCJ can be achieved with motion recovery after implant removal.

Results We present two cases of AOD treated with temporary fixation. A 12-year-old boy involved in a frontal car collision, as a strapped back seat passenger, was treated with temporary C0-C2 fixation for 10 months. Follow-up at 11 months after implant removal included clinical evaluation, computed tomography, magnetic resonance imaging (MRI), and flexion-extension X-rays. He was free of symptoms at follow-up. The CCJ was radiographically stable and he had 45 degrees of C1-C2 rotation.

A 7-year-old girl was hit by a car as she got off a bus. She was treated with temporary fixation for 4 months after which the implant was removed. Follow-up at 8 years included clinical evaluation and MRI in rotation. She was free of symptoms. The ligaments of the CCJ appeared normal and her C1-C2 rotation was 30 degrees.

Conclusion C0-C2 fixation without fusion allows the CCJ ligaments to heal in pediatric AOD. By removing the implants after ligament healing, rotation in the C1-C2 segment can be regained without subsequent instability. Both our patients tolerated the treatment well and were free of symptoms at follow-up.

By using minimally invasive muscle-preserving technique and navigation, temporary fixation of the CCJ can be achieved with minimal damage to the soft tissues allowing recovery of almost normal function after implant removal.

Keywords

navigation - atlanto-occipital dislocation - occipitocervical dissociation - craniocervical dissociation - muscle preservation - motion preservation

Authors' Contributions

Conception and design: M.H., C.O.

Surgical technique: M.H., C.O.,

Drafting the article: M.H., L.S.

Illustrations: L.S.

Photos: M.H.

Critically revising the article: C.O., A.J.

Study supervision: C.O.


Ethical Permission

Permission to perform this follow-up was approved by the Swedish Ethical Review Authority (registration number: 2020–03097).


All included patients consented to procedure.


Supplementary Material



Publication History

Received: 09 August 2022

Accepted: 20 October 2022

Article published online:
24 January 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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