[Transoral atlanto-axial plate fixation in the treatment of a malunited dens fracture and secondary atlanto-axial instability].

INTRODUCTION

A case of a 22-year-old patient with a malunited dens fracture and secondary atlanto-axial instability is presented. The significant narrowing of the spinal canal due to the atlanto-axial instability was associated with anterior myelon compression and neurological deficit.

METHODS

A transoral approach with odontoid resection and anterior atlanto-axial plate fixation was performed. With this technique the atlanto-axial subluxation was reduced and the myelon was decompressed.

RESULTS

The postoperative course was uneventful. The follow-up showed a complete remission of the neurological deficit and a bony fusion of the atlanto-axial joints.

CONCLUSIONS

The presented case illustrates the importance of an accurate initial diagnosis of the degree of instability and the need for short-term follow-up examinations. If atlanto-axial pseudarthrosis or malunion with anterior spinal cord compression occurs, a transoral procedure with odontoid resection and atlanto-axial plate fixation seems to be an excellent salvage procedure.