Magerl technique for children atlantoaxial rotatory subluxation

Abstract

Objective To discuss the feasibility and prognosis of magerl technique for children. Atlantoaxial Rotatory Subluxation. Methods 63 patients with Atlantoaxial Rotatory Subluxation were treated in our hospital, and 16 of whom were treated with bilateral C1, 2 posterior transarticular screw fixation and fusion. All cases aged from 8 to 14, with an average age of 11±2.3 years old. According to Fielding classification, 10 cases were in type II, and 6 in type III. 1 patient showed dizziness, 11 patients showed obvious appearance of deviation of head and neck; 14 patients showed varying degrees of occipito-cervical pain, and one patient showed incomplete paralysis. All patients had undergone Halo traction, then the Magerl surgery for atlantoaxial fixation fusion. Through follow-up and photograph of atlantoaxial mouth opening, lateral cervical X-ray and atlantoaxial 3D CT, the screw position and bone graft fusion were evaluated. The clinical and radiological outcomes were evaluated according to the Symon and Lavender clinical standard, the imaging index space available for the cord (SAC), and the atlas-dens interval (ADI). Results All cases were followed up for 3 to 98 months (mean 38±14.6 months). All patients had completed the bilateral UCSS screw fixation, and the symptoms were improved significantly, without neurological symptoms aggravated or complications such as neurovascular injury. All UCSS screw position through the atlantoaxial joint was accurate, without atlanto occipital joint activity limitation. All patients got bony fusion 3 to 6 months post-operation. The clinical recovery rate was 93.8%. The SAC of C1,2 segment increased by 6.06±1.29 mm postoperatively, which showed a significant difference compared with preoperative SAC. The SAC at the latest follow-up was 15.31±0.79 mm, showing no significant difference compared with that just postoperatively. The ADI at one month post-operatively decreased by 5.75±1.53 mm, showing a significant difference compared with preoperative SAC. The ADI at the latest follow-up was 1.94±0.57 mm, showing no significant difference compared with that just postoperatively. Conclusion Preoperative Halo-traction combined with Magerl surgery in treatment of children with atlantoaxial rotatory subluxation is a safe and effective method. Key words: Atlanto-axial joint; Dislocations; Child; Internal fixators; Spinal fusion