Transoral joint release of the dislocated atlantoaxial joints combined with posterior reduction and fusion for a late infantile atlantoaxial rotatory fixation - A case report

Study Design. A case of a late infantile atlantoaxial rotatory fixation is reported for which transoral anterior release was performed. Objectives. To report a patient who underwent transoral anterior release of the dislocated atlantoaxial joint for a case of late infantile atlantoaxial rotatory fixation and quadriparesis. Summary of Background Data. Infantile atlantoaxial rotatory fixation is diagnosed easily by using recently developed imaging techniques such as computed tomography, magnetic resonance imaging, and three-dimensional computed tomography. Nevertheless, patients in whom the condition has been overlooked still are encountered, and the reduction in these patients becomes impossible by traction or by simple posterior open reduction. Few reports on the management of type II-IV chronic atlantoaxial rotatory fixation in which an anterior surgery was performed exist in the literature, and no report exists in which atlantoaxial joint release on the both sides was attained. Methods. A 9-year-old girl had a type III atlantoaxial rotatory fixation and quadriparesis. She received direct skull traction and repeated manual reduction while she was awake or under general anesthesia. Neither reduction nor movement was obtained, according to the radiographs. Therefore, it was necessary to perform open reduction posteriorly and transorally to release the fixed and contracted joints between C1 and C2. Results. After the anterior release of the joints, there was an inherent force preventing a complete rotational reduction. However, after a successful posterior reduction and fusion, and for more than 4 years after surgery, neither rotatory displacement nor neurologic deterioration was noted. Conclusions. The authrs suggest that careful transoral anterior release of the atlantoaxial joint permits successful reduction in a case of chronic fixed atlantoaxial rotary fixation combined:with!cord compression.