TITLE:
C1C2 Wiring and Posttraumatic Atlantoaxial Dislocation: An Effective and Cheap Surgical Procedure in a Developing Country
AUTHORS:
Ibrahim Dao, Massimiliano Visocchi, Salah Sow, John Jabang, Ousmane Ouattara, Astride Somda, Abdoulaye Sanou, Elie Dibloni Nassoum, Arsène Tossou, Narcisse Ouedraogo, Frédéric Bako, Massadiami Soulama, Malick Diallo, Patrick Wendpouiré Hamed Dakouré
KEYWORDS:
Superior Cervical Spine, Dislocation, Fracture, Wiring, Screwing, Neurovegetative Disorders
JOURNAL NAME:
Surgical Science,
Vol.15 No.5,
May
23,
2024
ABSTRACT: Objectives: Atlantoaxial dislocation remains a rare and serious condition with a high preoperative and postoperative morbidity and mortality. Its successful surgical management is still challenging and gratifying for neurosurgeons. Several technics have been described such as wiring, trans articular screwing, C1C2 screwing with plate and screw introduced by Goel et al., and modified by insertion of polyaxially screw and rod many years later by Harms. Unavailability and expensiveness of upper cervical spine instrumentation device led us to C1C2 Wiring resulting in a good outcome. Finally, a quadriplegic patient with a more comfortable financial condition had ordered devices from abroad and benefit for Goel and Harms screwing technique and improved dramatically from ASIA A to ASIA E. Material and methods: This is a retrospective study of patients managed in our department by a same neurosurgeon from January 2019 to April 2024. Results: We defined 6 men and 1 woman with an average age of 33 years. Unrestrained driver in a rollover motor vehicle accident was most common. Only one patient was neurologically intact on admission. Neurovegetative disorders were noticed in one patient. Dislocation was associated to a fracture of the dens in two patients. Three patients have been successfully operated with remarkable outcome, mostly from ASIA A to E. Conclusion: C1C2 dislocation is a serious condition and C1C2 Wiring represents an effective and cheaper technic. Therefore, this technic should deserve consideration above all in low incomes countries when screwing devices are not available. Seatbelt should be demanded for motor vehicle drivers and passengers.