• Michael Payer and Cyrille C Sottas.
• Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland. mpayer@hotmail.com
• Neurosurgery. 2005 Jan 1; 56 (1 Suppl): E203; discussion E203.

Objective And ImportanceMore survivors of traumatic atlanto-occipital dislocation (AOD) in adults have recently been reported. Surgical management options are therefore of increasing interest. We present a new technique of posterior C0-C1-C2 fixation.Clinical PresentationA 29-year-old motorcyclist survived a traumatic vertical AOD of 15 mm. No spinal cord or medullary lesion was present. Brain contusion and diffuse axonal injuries led to a cortical biplegia, which recovered progressively over a period of 6 months. Twelve months after surgery, no neurological deficit was present except for slightly increased deep tendon reflexes.InterventionPosterior C0-C1-C2 fixation was performed with two bicortical occipital screws, one bicortical lateral mass screw in the atlas, and one monocortical pars screw in the axis on each side, connected to a plate-rod on the right and left sides. Fusion was performed with monocortical bone graft from the posterior iliac crest.ConclusionThe surgical technique described was thought to be safe to perform and resulted in immediate stability without external immobilization. Solid fusion was achieved 6 months after surgery.

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