Combined Procedure Allowing Atlantoaxial and Atlanto-Occipital Joint Motion for Complex Injuries in the Upper Cervical Spine

This study was performed to explore an ideal limited fixation method for the treatment of unstable atlantoaxial fractures that can preserve the range of motion of the occipital and atlantoaxial joints and restore the stability of the upper cervical spine. A 64-year-old man was diagnosed with a complicated injury of the upper cervical spine. The anterior and posterior approach was used to reconstruct the stability of the upper cervical spine while preserving the range of motion of the occipital and atlantoaxial joints. Preoperative imaging and neurologic examinations were performed. Follow-up lasted 24 months. The patient clinically improved after undergoing this novel procedure. Seven days postoperatively, the patient's visual analog scale score was 3. Follow-up contrast computed tomography showed good reduction and fixation in the upper cervical spine. Two weeks postoperatively, the patient displayed good cervical vertebral activity, with no restriction during flexion, extension, rotation, or other movements. No intraoperative or postoperative complications occurred. This modified procedure for restoration of cervical stability may be an improvement over traditional posterior fusion because atlantoaxial motion is preserved. [Orthopedics. 2020;43(4):e329-e333.].