Atlantooccipital transarticular screw fixation for the treatment of traumatic occipitoatlantal dislocation

Technical note

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✓ The authors describe a new technique of internal atlantooccipital screw fixation involving posterior wiring and fusion for the treatment of traumatic atlantooccipital dislocation, which was performed in a 17-year-old male patient involved in a motor vehicle accident and who suffered from atlantooccipital dislocation without neurological injury. At the 6-month follow-up examination, the patient was neurologically intact with a solid occipitocervical fusion and full range of motion of the neck.

Article Information

Address reprint requests to: Curtis A. Dickman, M.D., Neuroscience Publications, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, Arizona 85013-4496. email: neuropub@chw.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    Sagittal bone-window CT reconstructions of the cervical spine, revealing distraction of the atlantocondylar joint spaces consistent with AOD. With permission from Barrow Neurological Institute.

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    Upper: Sagittal bone-window CT reconstruction of the occipitocervical junction after placement of the posterior transarticular atlantooccipital screws. Lower: Coronal bone-window CT reconstruction of CCJ demonstrating the tip of the atlantooccipital screws in the occipital condyles (arrowheads) below the hypoglossal canal (arrows). With permission from Barrow Neurological Institute.

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    Left and Right: Sagittal (left) and posterior (right) illustrations of the CCJ after placement of the atlantooccipital transarticular screw. The entry point of the screw was at the caudal junction of the C-1 arch and lateral mass. The tip of the screw was directed so that it would be positioned in the condyle below the edge of the clivus dorsal to the basion. The cranial trajectory was approximately 45° with a 0° position relative to the sagittal plane. Reprinted with permission from Journal of Neurosurgery.

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