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Atlantoaxialis a combination of two words atlanto means the atlas bone (C1) and the axis bone (C2) is basically a joint present in the upper part of the neck. The first, known as the atlas (C1) and second known as the axis (C2) cervical vertebrae of a spinal cord. It is also known as pivot joint which is very helpful in the movement of head and neck. This pivot joint is very complex in nature and consists of no fewer than four distinct joints. Flexion and extension of the neck involves an articulation in between C1 and C2. When the atlantoaxial instability occurs more often in between C1 and C2 then Atlantoaxial Fixation is required. Patient with Down’s syndrome is often treated with Atlantoaxial Fixation
Atlantoaxial fixation is an advanced surgical technique performed majorly on the patients with odontoideum, neoplasm, infection and degenerative connective tissue disorders such as rheumatoid arthritis, genetic conditions such as HOX-D3 and Down syndrome, and heritable connective tissue disorders. Statistics shows that 50% of the global population still suffering from Atlantoaxial instability. Different techniques and surgeries are being performed on daily basis on these patients. Out of these the spine world came with a latest advanced surgical technique called Atlantoaxial Fixation which helps in the deformity and to cure instability soon.
Atlantoaxial fixation is performed when there is a dislocation or instability in C1 and C2 vertebras occurs. This surgical technique helps in fixing C1 and C2 which is responsible for the neck movements flexibly. The symptoms are:
Certain tests are recommended by or surgeons before they start surgery:
Fixation surgery is performed by a team of expert surgeons. Patient is subjected to position prone on neurosurgical operation table with the head in “U” position so as to prevent pressure points and eyes. A dose of general anaesthesia induced to the patient before surgery. Surgeons generally keep skull tongs after incision is made at pivot joints and after surgery tongs get removed and the incision is tightened for quick recovery. The fixation of C1 and C2 is performed by following methods:
Magerl/Screw technique: The Magerl is a computer assisted free hand technique. The Magerl technique can be summarized as the posterior atlantoaxial screw fixation technique. A cave like incision is made slight above C3 till anterior part of C1to reach C1 C2 is performed for the fixation. During this, screw is inserted two on right and two on left to the atlas and the axis in between C1 C2 to retain the mobility again.
Goel/Harm’s technique: Harm’s technique also referred as Goel technique, is performed in posterior atlantaxial stabilization. The Poly axial screw of selected length is passed usually without taping, which ensures safe hold of the screw. Depending on the CT scan reports the length of the screw varies, accordingly fixation of screw in C1 C2 is done.
After Atlantoaxial fixation surgery joint can easily move in any direction after sometime. Within one month after surgery, patient can resume all the major daily activities and feels far better than before. It helps the patients to get completely cured after long term illness and pain.
In neuro endoscopy, an endoscope is inserted through a small opening in the skull.
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