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Case Report NEWER TECHNIQUES FOR POSTERIOR REDUCTION AND STABILIZATION OF C1 - C2 DISLOCATION Sunil Sharma*, Raj Kumar** and S.K. Singh*** From the: Senior Consultant Neurosurgeon*, Junior Consultant Neurosurgeon**, Registrar***, Department of Neurosurgery, Apollo Hosptials, Bilaspur ( C.G.), India. Correspondence to: Dr. Sunil Sharma, Department of Neurosurgery, Apollo Hospitals, Bilaspur (C.G), India. CRANIO Vertebral junction including C1-C2 dislocation is a difficult anatomic area and different pathologies in the re- gion produces varied changes in mechanics. One of the common pathology of Cranio Vertebral junction is congenital mobile atlantoaxial dislocation where plain X-ray lateral view in flexion and in exten- sion clearly gives idea of treatment plan of reduction and stabilisation of C1-C2. In these cases extension of cervi- cal spine reduces the dislocation. But in some other cases it may not be so these unusual two cases are below de- scribed. Case 1 A 14-year-girl presented to us with history of neck pain and weakness of all four limbs after a history of fall from scooter around one week before admission. On examina- tion she was conscious oriented and had spastic quadriparesis. MRI cervical spine showed cord compres- sion at C1-C2 level. Plain X-rays Cranio Vertebral junction lateral view in flexion and in extension was done which showed C1-C2 dislocation with fracture odontoid which was confirmed on CT scan. She was planned for reduction and stabilisation of C1-C2 through posterior ap- proach. C-arm machine peroperatively could show us clearly that C1-C2 reduction was achieved only on distracting laminae and spinous process of C2 from C1 posterior arch. The Vertex system of Medtronic was the only implant, with its hooks facing away, to distract and reduce the disloca- tion. Hydroxyapetite blocks were used for bone graft. Post operatively she did not had any added neurological deficit and started gradually improving. At one year follow up she is absolutely normal and check X-ray Cranio Vertebral junction shows implant is in place. Case 2 A 40-year-old lady with Rheumatoid arthritis presented with spastic quadriparesis. MRI cervical spine shows cord compression at C1-C2 level. Plain X-ray Cranio Vertebral junction lateral view in flexion and in extension showed dislocation. Peroperatively C1 was found dislocated anteri- orly over C2 and could be pulled back for reduction. There was anterior-posterior translatory movement of C1 over C2. Reduction and fixation of C1-C2 was achieved using ti- tanium cable with iliac bone graft . Patient improved after surgery. COMMENTS These two cases gives insight about the various differ- ent pathophysiology causing C1-C2 dislocation. Each patient required different implant and manuver to achieve reduction & fixation of C1-C2 through posterior approach. Use of C-arm machine peroperatively is must in these un- usual cases in contrast to classical congenital mobile atlantoaxial dislocation. 70 Apollo Medicine, Vol. 2, March 2005
