Atlanto-occipital Fusion For Dislocation in Children With Neurologic Preservation

STUDY DESIGN: A retrospective clinical review of patients with atlanto-occipital dislocations. OBJECTIVES: To determine if fusion of the occiput to C1 can be accomplished without extension to the axis. SUMMARY OF BACKGROUND DATA: Patients with atlanto-occipital dislocations who have preservation of spinal cord function are quite rare. The standard approach to stabilization has been fusion of the occiput to the axis (C2). This may compromise rotation unnecessarily, however. The authors investigated the success of attempting to fuse only the occiput to C1 in children. METHODS: Two children with atlanto-occipital dislocation who had normal neurologic function underwent fusion from the occiput to the atlas after reduction. RESULTS: Both cases showed successful fusion with no unwanted extension to lower levels. Full head rotation was preserved. CONCLUSIONS: This technique restores stability without restricting rotation.