Surgical management of atlantoaxial dislocation and cervical spinal cord injury in craniopagus twins

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  • 1 Departments of Neurological Surgery and
  • 2 Anesthesia, Loyola University Medical Center, Maywood, Illinois
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A case of cervical spinal cord injury in 12-year-old angular craniopagus twins is presented, with a description of the planning and execution of surgical treatment along with subsequent clinical outcome. The injury occurred following a fall from a standing position, resulting in quadriparesis in one of the twins. Imaging revealed severe craniocervical stenosis resulting from a C1–2 dislocation, and T2-weighted hyperintensity of the cervical spinal cord. After custom halo fixation was obtained, a posterior approach was utilized to decompress and instrument the occiput, cervical, and upper thoracic spine with intraoperative reduction of the dislocation. Early neurological improvement was noted during the acute postoperative phase, and 27 months of follow-up demonstrated intact instrumentation with continued neurological improvement to near baseline. The complexity of managing such an injury, inclusive of the surgical, anesthetic, biomechanical, and ethical considerations, is described in detail.

ABBREVIATIONS AIR = acute inpatient rehabilitation; LUMC = Loyola University Medical Center; OR = operating room; PICU = pediatric intensive care unit; POD = postoperative day; SCI = spinal cord injury.

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Contributor Notes

Correspondence Russ P. Nockels: Loyola University School of Medicine, Maywood, IL. rpnockels@gmail.com.

INCLUDE WHEN CITING Published online August 28, 2020; DOI: 10.3171/2020.5.SPINE20537.

Disclosures Dr. Nockels reports being a consultant for and receiving royalties from Medtronic.

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