Publication year: 2011
Source: World Neurosurgery, Available online 24 December 2011
Edward C. Benzel, Donald H. Zhang, Christopher Iannotti, Daniel Refai, Paul Ruggieri, ...
BackgroundFor children who survive traumatic AOD, early surgical stabilization and arthrodesis of the occipito-atlanto-axial complex is typically performed. Due to the unique and crowded anatomy of the occipito-cervical junction, the creation of a fusion construct that is both safe and biomechanically sound is extremely challenging, especially in infants. We present a technical report of infantile type I AOD with gross instability, who underwent surgical stabilization consisting occiput to C2 arthrodesis using autologous rib, augmented with BMP-2, Mersiline suture, and Ethibond suture as 'cross connectors'.Technical DescriptionThe patient is a 12 month-old female who was involved in a high-speed motor vehicle accident and sustained a type I atlanto-occipital dislocation (AOD). Definitive surgical stabilization consisting of arthrodesis from the occiput to C2 using autologous rib augmented with BMP-2, Mersiline suture, and Ethibond suture as 'cross connectors' was performed. There were no intraoperative complications. A follow-up cervical spine CT obtained 12 weeks post-operatively demonstrated excellent occipito-cervical alignment, with evidence of modest bony fusion from the occiput to C2. The neurological examination demonstrated modest, but progressive, improvement, with partial resolution of bilateral sixth nerve palsies, and improvement in upper and lower extremity muscle strength and tone.ConclusionSignificant surgical challenges exist regarding occipito-cervical fusion in infants with AOD and gross instability. This case report illustrates the successful application of BMP-2-augmented occipito-cervical fusion using autologous rib, in combination with Mersiline and ethibond suture, in the treatment of an infant with type I AOD with gross instability.
Source: World Neurosurgery, Available online 24 December 2011
Edward C. Benzel, Donald H. Zhang, Christopher Iannotti, Daniel Refai, Paul Ruggieri, ...
BackgroundFor children who survive traumatic AOD, early surgical stabilization and arthrodesis of the occipito-atlanto-axial complex is typically performed. Due to the unique and crowded anatomy of the occipito-cervical junction, the creation of a fusion construct that is both safe and biomechanically sound is extremely challenging, especially in infants. We present a technical report of infantile type I AOD with gross instability, who underwent surgical stabilization consisting occiput to C2 arthrodesis using autologous rib, augmented with BMP-2, Mersiline suture, and Ethibond suture as 'cross connectors'.Technical DescriptionThe patient is a 12 month-old female who was involved in a high-speed motor vehicle accident and sustained a type I atlanto-occipital dislocation (AOD). Definitive surgical stabilization consisting of arthrodesis from the occiput to C2 using autologous rib augmented with BMP-2, Mersiline suture, and Ethibond suture as 'cross connectors' was performed. There were no intraoperative complications. A follow-up cervical spine CT obtained 12 weeks post-operatively demonstrated excellent occipito-cervical alignment, with evidence of modest bony fusion from the occiput to C2. The neurological examination demonstrated modest, but progressive, improvement, with partial resolution of bilateral sixth nerve palsies, and improvement in upper and lower extremity muscle strength and tone.ConclusionSignificant surgical challenges exist regarding occipito-cervical fusion in infants with AOD and gross instability. This case report illustrates the successful application of BMP-2-augmented occipito-cervical fusion using autologous rib, in combination with Mersiline and ethibond suture, in the treatment of an infant with type I AOD with gross instability.
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Júlio Leonardo B. Pereira
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