The application of atlantoaxial screw and rod fixation in revision operations for postoperative re-dislocation in children.

Introduction: We evaluate the feasibility, safety, and efficacy of atlantoaxial screw and rod fixation for revision operations in the treatment of re-dislocation after atlantoaxial operations in children.

Methods: Eight consecutive children with atlantoaxial instability required a revision operation due to atlantoaxial re-dislocation caused by the failure of the initial posterior wire fixation. The children were 5-11 years of age with an average age of 8.5 years. The posterior atlantoaxial screw and rod fixation and fusion operation was then performed. Autograft bones harvested from rib (in 3 patients), local bone (2 patients), and the iliac crest bone (3 patients) were used.

Results: There were no complications such as vertebral artery or spinal cord injury during the operations or loosening or fracture of the fixations after the operations. Stability and reduction of the atlantoaxial segments were achieved in all patients postoperatively. Follow-up time was 24-55 months, with an average of 35 months. All patients achieved solid osseous fusion demonstrated on plain radiographs or CT scanning. Atlantoaxial screw and rod fixation is feasible in children and may be considered for use during the initial operation in the treatment of atlantoaxial dislocation in children to minimize the need for a revision operation.

Conclusion: If a revision operation is required, atlantoaxial screw-rod fixation is a safe and effective method. Because the anatomical structure is complicated in revision operation patients, CAD-RP technology could guide the the procedures of exposure and screw placement.