Double insurance atlantoaxial fixation

Abstract

Background An alternative technique of atlantoaxial fixation is described, which combines the trans-articular method of fixation described by Magerl in 1982 and the interarticular technique described by us in 1988. Methods Between January 2001 and January 2005, 18 patients underwent the discussed method of fixation at the Department of Neurosurgery at King Edward VII Memorial Hospital in Mumbai, India. Fifteen patients had congenital craniovertebral anomaly and 3 patients had posttraumatic atlantoaxial instability. Fourteen patients had basilar invagination with “fixed” atlantoaxial dislocation, and 4 patients had mobile and reducible atlantoaxial dislocation. The mean follow-up period was 22 months (range, 3-50 months). Results Successful atlantoaxial stabilization was achieved in all patients and was documented with dynamic radiography. There was no incidence of implant rejection. There were no neurological, vascular, or infective complications. Conclusion The described method of atlantoaxial fixation that incorporates the advantages of the 2 currently more frequently used techniques of lateral mass fixation could be an alternative method of fixation.