• Yeon-Seong Kim, Jung-Kil Lee, Sung-Jun Moon, and Soo-Han Kim.
• Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Korea.
• Spine. 2007 Nov 1; 32 (23): E682-7.

Study DesignA case report.ObjectiveTo describe an interesting patient who underwent open reduction and C1-C2 transpedicular screw fixation with interspinous wiring due to high-riding vertebral artery.Summary Of Background DataAtlantoaxial rotatory fixation (AARF) is a rare complication found most frequently after trauma in children and young adults; the clinical diagnosis is difficult and often made late.MethodsWe report a case of post-traumatic AARF associated with a facet fracture in an adult. Reduction proved difficult to obtain by skull traction and gentle manipulation. Therefore, after open reduction under general anesthesia, we performed C1-C2 transpedicular screw fixation with posterior wiring to avoid vertebral artery injury due to high-riding transverse foramen at the C2 vertebra.ResultsThe normal atlantoaxial relation was restored and the torticollis resolved. The patient remains neurologically intact and has radiographic documentation of fusion.ConclusionAlthough technically demanding, C1-C2 transpedicular screw fixation combined with interspinous bone graft wiring after open reduction may be an alternative treatment option if conservative treatment fails to reduce AARF.

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