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Posterior spinal fusion using a unilateral C1 posterior arch screw and a C2 laminar screw for atlantoaxial fracture dislocation.

Research paper by Yuichi Y Ono, Naohisa N Miyakoshi, Michio M Hongo, Yuji Y Kasukawa, Yoshinori Y Ishikawa, Daisuke D Kudo, Ryota R Kimura, Jumpei J Iida, Yoichi Y Shimada

Indexed on: 28 Nov '19Published on: 21 May '19Published in: SAGE Open Medical Case Reports



Abstract

C1 lateral mass screws and C2 pedicle screws are usually chosen to fix atlantoaxial (C1-C2) instability. However, there are a few situations in which these screws are difficult to use, such as in a case with a fracture line at the screw insertion point and bleeding from the fracture site. A new technique using a unilateral C1 posterior arch screw and a C2 laminar screw combined with a contralateral C1 lateral mass screws-C2 pedicle screws procedure for upper cervical fixation is reported. A 24-year-old woman had an irreducible C1-C2 anterior dislocation with a type III odontoid fracture on the right side due to a traffic accident. The patient underwent open reduction and posterior C1-C2 fixation. On the left side, a C1 lateral mass screws and a C2 pedicle screws were placed. Because there was bleeding from the fracture site and a high-riding vertebral artery was seen on the right side, a C1 posterior arch screw and a C2 laminar screw were chosen. Eight months after the surgery, computed tomography scans showed healing of the odontoid fracture with anatomically correct alignment. Although there have been few comparable studies, fixation with unilateral C1 posterior arch screw-C2 laminar screw could be a beneficial choice for surgeries involving the upper cervical region in patients with fracture dislocation or arterial abnormalities.