A new technique for reduction of atlantoaxial subluxation using a simple tool during posterior segmental screw fixation

Clinical article

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  • 1 Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Sungnam, Korea;
  • 2 Department of Orthopaedic Surgery, Washington University in St. Louis, Missouri; and
  • 3 Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea
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Object

The authors introduce a simple technique and tool to facilitate reduction of atlantoaxial subluxation during posterior segmental screw fixation.

Methods

Two types of reduction tool have been designed: T-type and L-type. A T-shaped levering tool was used when a pedicle or pars screw was used for C-2, and an L-shaped tool was used when a laminar screw was used for C-2. Twenty-two patients who underwent atlantoaxial segmental screw fixation and fusion for the treatment of anteroposterior instability or subluxation, using either of these new types of reduction tool, were enrolled. Demographic, clinical, and surgical data, which had been prospectively collected in a database, were analyzed. The atlantodens interval was measured on lateral radiographs, and the space available for the spinal cord was measured on CT scans.

Results

The authors could attain reduction of the atlantoaxial subluxation without difficulty using either type of tool. The preoperative atlantodens interval ranged from −16.9 to 10.9 mm in a neutral position, and the postoperative interval ranged from −2.8 to 3.0 mm, with negative values due to extension-type or mixed-type instability. The mean space available for the spinal cord significantly increased, from 9.5 mm preoperatively to 15.4 mm postoperatively (p < 0.001).

Conclusions

This technique allowed for controlled manipulation and reduction of the atlantoaxial subluxation without difficulty.

Abbreviations used in this paper:ADI = atlantodens interval; JOA = Japanese Orthopaedic Association; NDI = Neck Disability Index; SAC = space available for the spinal cord; VAS = visual analog scale.

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Contributor Notes

Address correspondence to: Jin S. Yeom, M.D., Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-ku, Sungnam 463-707, Republic of Korea. email: highcervical@gmail.com.

Please include this information when citing this paper: published online June 21, 2013; DOI: 10.3171/2013.5.SPINE12859.

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