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Posterior occipito-axial fixation applied C2 laminar screws for pediatric atlantoaxial instability caused by Down syndrome: Report of 2 cases

Hiroshi Kuroki, Shinichiro Kubo, Hideaki Hamanaka and Etsuo Chosa
International Journal of Spine Surgery January 2012, 6 210-215; DOI: https://doi.org/10.1016/j.ijsp.2012.05.002

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Figures

  • Fig. 1
    Fig. 1

    Preoperative X-ray and CT scan in case 1. On plain radiographs, the cervical spine showed malalignment at the atlantoaxial level with torticollar deformity. Plain CT showed not only sagittal but also axial dislocation of the atlantoaxial joint with os odontoideum. (a-p, anteroposterior; 3D, 3-dimensional.)

  • Fig. 2
    Fig. 2

    Preoperative magnetic resonance image (T1WI: T1-weighted image, T2WI: T2-weighted image) in case 1. The spinal cord snaked through into the spinal canal, but high-intensity change of the spinal cord on the T2WI was not observed.

  • Fig. 3
    Fig. 3

    Morphologic analysis of C2 pedicles by CT imaging in case 1. Insertion of pedicle screws was judged dangerous on both sides by CT imaging. (lt, left; rt, right.)

  • Fig. 4
    Fig. 4

    Postoperative X-ray (obtained 1 year 3 months after surgery) and CT scan (obtained 4 weeks after surgery) in case 1. Alignment of the cervical spine had improved, and the positions of the bilateral C2 laminar screws were correct. (a-p, anteroposterior.)

  • Fig. 5
    Fig. 5

    Preoperative X-ray and CT scan in case 2. On dynamic radiographs, marked instability at the atlantoaxial joint was observed. Plain CT showed atlantoaxial subluxation with os odontoideum. (3D, 3-dimensional.)

  • Fig. 6
    Fig. 6

    Preoperative magnetic resonance image (T1WI: T1-weighted image, T2WI: T2-weighted image) in case 2. Severe spinal canal stenosis accompanied by high-intensity change of the spinal cord on the T2WI was clearly observed at the atlantoaxial level.

  • Fig. 7
    Fig. 7

    Morphologic analysis of C2 pedicles by CT imaging in case 2. Insertion of pedicle screws was judged dangerous on the left side by CT imaging. (lt, left; rt, right.)

  • Fig. 8
    Fig. 8

    Postoperative X-ray (obtained 1 year 6 months after surgery) and CT scan (obtained 1 week after surgery) in case 2. Alignment of the cervical spine had improved, and the accurate insertion of both right C2 pedicle and left C2 laminar screws was confirmed. (a-p, anteroposterior.)

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Posterior occipito-axial fixation applied C2 laminar screws for pediatric atlantoaxial instability caused by Down syndrome: Report of 2 cases
Hiroshi Kuroki, Shinichiro Kubo, Hideaki Hamanaka, Etsuo Chosa
International Journal of Spine Surgery Jan 2012, 6 210-215; DOI: 10.1016/j.ijsp.2012.05.002
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