Miyao Yasuyoshi, Sasaki Manabu, Umegaki Masao, Yonenobu Kazuo
Department of Neurosurgery, Suita Municipal Hospital, Suita, Osaka, Japan.
Department of Neurosurgery, Iseikai Hospital, Osaka, Osaka, Japan.
NMC Case Rep J. 2017 Jun 9;4(3):63-66. doi: 10.2176/nmccrj.cr.2016-0270. eCollection 2017 Jul.
Atlantoaxial rotatory fixation (AARF) occurs commonly in children who have undergone trauma. It is usually corrected with conservative therapy. In this report, however, the patient was an adult with AARF who was treated surgically. A 64-year-old woman presented with a 1-year history of spastic gait and hand clumsiness. Imaging studies revealed the presence of AARF, os odontoideum, and severe spinal cord compression at that spinal level. As the AARF had not been responded to head traction with a halo device, we decided to treat the patient with in situ posterior fixation. Because the rigid dislocation was present between the atlas and the axis, we were forced to make an unusual instrumentation construct. Neurological symptoms other than hand numbness diminished after the surgery, and arthrodesis was obtained between the occiput and the axis. It should be noted that surgical planning for posterior instrumentation construct is required when rigid AARF is treated surgically.
寰枢椎旋转固定（AARF）常见于受过外伤的儿童。通常采用保守治疗。然而，在本报告中，患者为一名患有AARF的成年人，接受了手术治疗。一名64岁女性，有1年痉挛性步态和手部笨拙病史。影像学检查显示存在AARF、齿突骨和该脊髓节段的严重脊髓受压。由于AARF对头颅牵引和头环装置无反应，我们决定对患者进行原位后路固定治疗。由于寰椎和枢椎之间存在僵硬脱位，我们被迫采用一种特殊的内固定结构。术后除手部麻木外的神经症状减轻，枕骨和枢椎之间实现了关节融合。需要注意的是，当对僵硬的AARF进行手术治疗时，需要进行后路内固定结构的手术规划。
