Treatment of atlantoaxial instability in pediatric patients.

Scott Y Rahimi, E. Andrew Stevens, David John Yeh, Ann Marie Flannery, Haroon F Choudhri, Mark R. Lee

Research output: Contribution to journalReview article

50 Citations (Scopus)

Abstract

The atlantoaxial region has been extensively described as a spinal segment especially prone to injury in children. In this clinical review, the authors evaluate and summarize the management of 23 pediatric cases of atlantoaxial instability treated between March 1990 and October 2002. Four broad categories of atlantoaxial problems were observed-atlantoaxial rotatory subluxation in six patients, anterior-posterior atlantoaxial instability caused by ligamentous injury or congenital ligamentous laxity (10 patients), atlantoaxial fracture with or without dislocation (five patients), and atlantooccipital dislocation (two patients). Most cases (60.9%) were treated without surgical intervention, resulting in excellent outcomes; however, 21.7% of cases were treated with a cervical halo (mean patient age 72.6 months) alone for 3 months. Various techniques of surgical stabilization including transarticular screws with sublaminar wiring, transoral decompression with posterior plating, and laminectomy with Steinmann pin occipital-cervical fusion were used with good results. Both patients with atlantooccipital dislocation underwent immediate Locksley occipital-cervical fusion, with marked neurological improvement. Individualized case management must be based on clinical presentation, with internal fixation being the last resort.

Original languageEnglish (US)
JournalNeurosurgical Focus
Volume15
Issue number6
StatePublished - Jan 1 2003

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Pediatrics
Therapeutics
Laminectomy
Wounds and Injuries
Case Management
Decompression

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Rahimi, S. Y., Stevens, E. A., Yeh, D. J., Flannery, A. M., Choudhri, H. F., & Lee, M. R. (2003). Treatment of atlantoaxial instability in pediatric patients. Neurosurgical Focus, 15(6).

Treatment of atlantoaxial instability in pediatric patients. / Rahimi, Scott Y; Stevens, E. Andrew; Yeh, David John; Flannery, Ann Marie; Choudhri, Haroon F; Lee, Mark R.

In: Neurosurgical Focus, Vol. 15, No. 6, 01.01.2003.

Research output: Contribution to journalReview article

Rahimi, SY, Stevens, EA, Yeh, DJ, Flannery, AM, Choudhri, HF & Lee, MR 2003, 'Treatment of atlantoaxial instability in pediatric patients.', Neurosurgical Focus, vol. 15, no. 6.
Rahimi SY, Stevens EA, Yeh DJ, Flannery AM, Choudhri HF, Lee MR. Treatment of atlantoaxial instability in pediatric patients. Neurosurgical Focus. 2003 Jan 1;15(6).
Rahimi, Scott Y ; Stevens, E. Andrew ; Yeh, David John ; Flannery, Ann Marie ; Choudhri, Haroon F ; Lee, Mark R. / Treatment of atlantoaxial instability in pediatric patients. In: Neurosurgical Focus. 2003 ; Vol. 15, No. 6.
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