• Journal of Korean Neurosurgical Society
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• v.48 no.5
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• pp.452-454
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• 2010

Traumatic atlantoaxial rotatory fixation (AARF) with accompanying odontoid and C2 articular facet fracture is a very rare injury, and only one such case has been reported in the medical literature. We present here a case of a traumatic AARF associated with an odontoid and comminuted C2 articular facet fracture, and this was treated with skull traction and halo-vest immobilization for 3 months. After removal of the halo-vest immobilization, his neck pain was improved and his neck motion was preserved without any neurologic deficits although mild torticolis was still observed in closer inspection.

• Journal of Korean Neurosurgical Society
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• v.29 no.11
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• pp.1469-1475
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• 2000

Objective : The goal of this study was to evaluate the clinical outcome of the posterior C1-2 transarticular screw fixation without C1-2 sublaminar wiring in atlantoaxial instability. Methods : Between Apr. 1995 and Feb. 2000, we used this technique in treat randomly selected 17 patients (11 men, 6 women) who had atlantoaxial instability. The causes of instability were : type II-A odontoid process fracture(10 cases) ; type II-P odontoid process fracture(1 case) ; Os odontoideum(2 cases) ; transverse ligament laxity due to rheumatoid disease(1 case) ; and, transverse ligament injury without bone fracture(3 cases). All cases were operated with posterior C1-2 transarticular screw fixation with 3.5mm cortical screw and interlaminar iliac graft without sublaminar wire fixation. The mean follow-up period was 28 months(5 to 58 months) and the mean age at the time of operation was 41 years(15 to 68 years). All Patients were allowed to ambulate with Philadelphia neck collar on the first post-operation day. Results : Bony fusion was successfully achieved in all cases demonstrated at 3-month follow-up studies. There was no operative mortality or morbidity. Conclusion : The authors conclude that the posterior transarticular screw fixation without C1-2 sublaminar wiring provide adequate stability with high bony union rate in atlantoaxial instability of various causes.

• Journal of Trauma and Injury
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• v.19 no.2
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• pp.164-172
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• 2006

Background: The authors conducted a retrospective study to evaluate the mechanism of injury, the surgical techniques, the clinical features, the combined injuries, the treatment results, and the surgical complications in patients with atlantoaxial fracture/subluxations. Methods: The authors reviewed 71 cervical fracture/dislocations during a four-year period from September 2002 to August 2006. Among them, there were twenty one C1,2 fracture/subluxations. There were thirteen men (mean age : 43.5 years) and eight women (mean age : 50 years). Their follow-up period was at least 6 months, and the mean follow-up period was 9.6 months. Gardner-Wells tongs traction was used in all patients immediately on presentation. Surgical treatment was performed, depending on the pathologic conditions. Results: Of all 21 cases, 14 cases were injured in motor vehicle accidents, 5 were falls, and 2 were miscellaneous. There were four C1 fracture (5.6%), fourteen C2 fracture (66.7%), one C1 and 2 combined fracture (4.8%), and one C1-2 subluxation (4.8%). The C1 fractures in our series were classified as two Jefferson's fractures and two C1 lateral mass fracture. The C2 fractures were classified as one odontoid type I fracture, two odontoid type II fractures, five odontoid type III fractures, one hangman's fracture, and four C2 body tear-drop fractures. Atlantoaxial fractures were associated with six (28.6%) head injuries, four (19.0%) other spinal injuries, two (9.5%) chest injuries, and three (14.3%) spinal cord injuries. Surgical treatment was performed in nine cases, which included anterior odontoid screw fixation in two cases, transarticular screw fixation with iliac bone graft in one case, posterior fixation by using C2 pedicle screw and C3 lateral mass screw in three cases, lateral mass screw fixation C1-2 with iliac bone graft in one case, O(occipito)-C1-3-4 screw fixation in one case, posterior C2-3 wiring with allograft in one case, and halo vest in six cases. Conservative management was used in the rest of the patients in our trials. Bone fusion was complete in all cases. There were no operation-related complication, except one pin site infection in the case of halo vest. Conclusion: In this study, the choice of appropriate treatment according to the fracture types resulted in safe and effective management of unique atlantoaxial fracture/subluxations.

• Proceedings of the Korean Society of Veterinary Clinics Conference
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• 2008.05a
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• pp.126-126
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• 2008

• Journal of Korean Neurosurgical Society
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• v.47 no.3
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• pp.221-223
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• 2010

C1 lateral mass and C2 pedicle (C1LM-C2P) fixation is a relatively new technique for atlantoaxial stabilization. Complications from C1LM-C2P fixation have been rarely reported. The authors report unilateral rod migration into the posterior fossa as a rare complication after this posterior C1-C2 stabilization technique. A 23-year-old man suffered severe head trauma and cervical spine injury after vehicle accident. He was unconscious for 2 months and regained consciousness. He underwent C1LM-C2P fixation for stabilization of type II odontoid process fracture described by Harms. The patient recovered without a major complication. Twenty months after operation, brain computed tomogram performed at psychology department for disability evaluation showed rod migration into the right cerebellar hemisphere. The patient had mild occipital headache and dizziness only regarding the misplaced rod. He refused further operation for rod removal. To our knowledge, this complication is the first report regarding rod migration after Harms method. We should be kept in mind the possibility of rod migration, and C1LM-C2P fixation should be performed with meticulous technique and long-term follow-up.

• The Korean Journal of Pain
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• v.25 no.4
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• pp.258-261
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• 2012

Posterior neck pain is a common complaint of patients in the pain clinic. The atlas (C1) burst fracture is known to be a cause of posterior neck pain and instability. Although the atlas burst fracture and instability can be discovered by plain X-rays which show lateral mass displacement or widening of the atlantodental interval, assessment of an atlas burst fracture can be difficult if there is no instability in the imaging study. Here we report a case of a 46-year-old female patient who had complained of sustained posterior neck pain for 6 months. Plain X-rays showed only disc space narrowing at C4/5 and C5/6, without any cervical instability. However, an unrecognized C1 lateral mass fracture was detected by CT and MRI. The patient's pain was then successfully treated after atlantoaxial joint injection with a C2 DRG block.

• Journal of Korean Neurosurgical Society
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• v.45 no.3
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• pp.164-168
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• 2009

Objective : Bilateral C1-2 transarticular screw fixation (TAF) with interspinous wiring has been the best treatment for atlantoaxial instability (AAI). However, several factors may disturb satisfactory placement of bilateral screws. This study evaluates the usefulness of unilateral TAF when bilateral TAF is not available. Methods : Between January 2003 and December 2007, TAF was performed in 54 patients with AAI. Preoperative studies including cervical x-ray, three dimensional computed tomogram, CT angiogram, and magnetic resonance image were checked. The atlanto-dental interval (ADI) was measured in preoperative period, immediate postoperatively, and postoperative 1, 3 and 6 months. Results : Unilateral TAF was performed in 27 patients (50%). The causes of unilateral TAF were anomalous course of vertebral artery in 20 patients (74%), severe degenerative arthritis in 3 (11%), fracture of C1 in 2, hemangioblastoma in one, and screw malposition in one. The mean ADI in unilateral group was measured as 2.63 mm in immediate postoperatively, 2.61 mm in 1 month, 2.64 mm in 3 months and 2.61 mm in 6 months postoperatively. The mean ADI of bilateral group was also measured as following; 2.76 mm in immediate postoperative, 2.71 mm in 1 month, 2.73 mm in 3 months, 2.73 mm in 6 months postoperatively. Comparison of ADI measurement showed no significant difference in both groups, and moreover fusion rate was 100% in bilateral and 96.3% in unilateral group (p=0.317). Conclusion : Even though bilateral TAF is best option for AAI in biomechanical perspectives, unilateral screw fixation also can be a useful alternative in otherwise dangerous or infeasible cases through bilateral screw placement.

• Proceedings of the Korean Society of Veterinary Clinics Conference
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• 2009.04a
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• pp.225-225
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• 2009

• Journal of Veterinary Clinics
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• v.26 no.5
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• pp.490-494
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• 2009

A 2-year-old Maltese and a 5-month-old Yorkshire terrier were presented with ataxia. Tetraparesis was observed in a 9-year -old Yorkshire terrier. The localizations of the lesions suggested brain or cervical spinal cord by the neurological examination, and the following images was achieved: radiography, axial images of computed tomography (CT), reconstruction image of CT such as multi-planar reformation(MPR) and 3-dimensional(3D) reconstruction and magnetic resonance imaging (MRI). On radiography, the misalignment between atlas (C1) and axis (C2), absent dens of axis, and increased space between the dorsal arch of C1 and spinous process of C2 were found. The discontinuation between dens and body of C2 was identified through axial CT images, and the fragmentation of dens separated from axis was observed through MPR and 3D image in all case. The hyperintense lesions and the spinal cord compression on T2-weighted MR images were represented in a dog with tetraparesis, the others represented only spinal cord compression. Three dogs were diagnosed as atlantoaxial instability (AAI) by dens fracture of C2. The dog with tetraparesis was euthanized due to guarded prognosis. The others were recovered completely. It is difficult to differentiate dens fracture of C2 from abnormal dens such as agenesis and hypoplasia. We thought that CT is very useful to evaluate the dens of C2 and differentiate the causes of AAI, and the reconstruction images of CT such as MPR and 3D make the translation of the fragmented dens or axis of AAI more precisely evaluate.

• Journal of Veterinary Clinics
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• v.30 no.6
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• pp.499-502
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• 2013

An eight-year-old, castrated male, Poodle dog was presented with a bite wound in the neck region. Clinical examination revealed non-ambulatory signs of tetraparesis with deep pain, and upper motor neuron changes in all limbs. Fractures of the transverse process of C1 and the dorsal spinous process of C2 were observed on the radiographs and the computed tomography (CT). Conservative therapy was performed for 1 week. However the neurological problems were not alleviated until 7 days after injury. The owners agreed to perform surgical stabilization. The surgical stabilization was performed 7 days after presentation. Ventral stabilization was performed with screws, K-wires and bone cement. The dog stood up independently after 4 weeks and was able to walk 6 weeks postoperatively. In this report we suggest that using combined stabilization techniques are effective for this type of cervical fracture in which the dorsal and ventral structures of the vertebra are severely disrupted.