Padalkar Pravin
Center for Orthopaedic Superspeciality and Spine Surgery, Khanda Colony, New Panvel, Navi Mumbai, India; Department of Orthopedics and Spine Surgery, Raigad Hospital and Research Center, Raigad, Maharashtra, India.
J Craniovertebr Junction Spine. 2016 Jul-Sep;7(3):184-8. doi: 10.4103/0974-8237.188410.
Atlantoaxial rotatory fixation (AARF) is a rare condition and delayed diagnosis. We report a case of chronic neglected atlantoaxial rotatory subluxation in adolescence child that was treated by serial skull traction followed by posterior fusing by method pioneered by Goel et al. A 15-year-old male presented with signs of high cervical myelopathy 2 years after trauma to neck childhood. There was upper cervical kyphosis, direct tenderness over C2 spinous process, atrophy of both hand muscles with weakness in grip strength. Reflexes in upper and lower extremities were exaggerated. Imaging showed Type 3 (Fielding and Hawkins) rotatory atlantoaxial dislocation (AAD). Treatment options available were 1. Staged anterior Transoral release & reduction followed by posterior fusion described by Govender and Kumar et al, 2. Posterior open reduction of joint and fusion, 3. Occipitocervical fusion with decompression. Our case was AARF presented to us with almost 2-year post injury. Considering complications associated with anterior surgery and posterior open reduction, we have opted for closed reduction by serially applying weight to skull traction under closed neurological monitoring. We have serially increased weight up to 15 kg over a period of 1 week before. We have achieved some reduction which was confirmed by traction lateral radiographs and computerized axial tomography scan. Residual subluxation corrected intra-operatively indirectly by using reduction screws in Goel et al.
Finally performed for C1-C2 fusion to take care of Instability. We like to emphasis here role of closed reduction even in delayed and neglected cases.
寰枢椎旋转固定（AARF）是一种罕见病症且诊断延迟。我们报告一例青少年慢性被忽视的寰枢椎旋转半脱位病例，该病例通过连续颅骨牵引治疗，随后采用Goel等人开创的方法进行后路融合。一名15岁男性在童年颈部受伤2年后出现高位颈髓病体征。存在上颈椎后凸，C2棘突处有直接压痛，双手肌肉萎缩且握力减弱。上下肢反射亢进。影像学显示为3型（Fielding和Hawkins）旋转性寰枢椎脱位（AAD）。可用的治疗选择有：1. 分期经口前路松解复位，随后按Govender和Kumar等人所述进行后路融合；2. 后路关节切开复位及融合；3. 枕颈融合减压。我们的病例是受伤后近2年出现的AARF。考虑到前路手术和后路切开复位相关的并发症，我们选择在闭合神经监测下通过对颅骨牵引连续施加重量进行闭合复位。在1周时间内我们将重量逐步增加至15千克。通过牵引侧位X线片和计算机断层扫描证实已实现一定程度的复位。术中通过使用Goel等人所述的复位螺钉间接纠正了残留的半脱位。
最后进行了C1 - C2融合以处理不稳定情况。我们在此强调即使在延迟和被忽视的病例中闭合复位的作用。
