Gallie atlantoaxial joint fusion

Gallie atlantoaxial fusion for the surgical treatment of odontoid deformities. A odontoid deformity is a rare congenital malformation, including odontogenic dysplasia, odontoid distal bone, odontoid separation, and odontoid absence. The odontoid deformity is fixed only to the atlantoaxial joint by local ligamentous tissue, which makes the local instability, and it is easy to cause spinal cord injury due to dislocation caused by trauma. Clinically, it can be asymptomatic, but when it is slightly traumatized, symptoms of medullary or upper cervical spinal cord compression may occur. Reports in the literature are mostly affected by adolescents, manifested by decreased muscle strength, ataxia, pain in the lower part of the pillow and neck, torticollis, muscle tension, and limited mobility. Some may be progressive numbness of the limbs, and severe cases of quadriplegia and death. Most of the treatments advocate active surgery. For unintentional examinations, it is controversial whether or not to prevent the instability of the odontoid before and after the astigmatism is less than 5 mm, because the neck activity of the sick child is difficult to be accepted by the sick child and parents. The pros and cons of surgical and non-surgical treatment should be clearly explained before making a decision on whether or not to perform preventive fusion. For those with pain in the neck, the neck support can be fixed first. If no improvement is made, the atlantoaxial fusion is performed. For patients with unstable cervical spine and radiculopathy, occipitocervical fusion is feasible. For the cervical spinal cord compression, the posterior or posterior atlantoaxial laminectomy is performed, the occipital foramen is enlarged, and the fibrous band is removed to relieve the oppression of the cerebellum, the medulla and the upper cervical spinal cord, and then the occipitocervical fusion is performed. Atlantoaxial fusion has many methods, among which Gallie, Brook and Jenkins are the most commonly used methods. The advantage of the Gallie method is that only one wire passes through the atlas of the atlas, but the disadvantage is that tightening the wire can cause unstable atlas. Shift backwards and finally merge at a dislocated position. The disadvantage of the Brooks method is that it is necessary to wear a wire under the vertebral arch of the atlas and the vertebral arch to increase the risk of surgery, but it can resist rotation, lateral and posterior extension. The thickness of the steel wire used should be selected from 18 to 22 depending on the age of the sick child and the size of the spinal canal. Children under the age of 6 cannot use wire fixation and instead place the bone graft in the fusion site where the cortical bone is removed. Use Halo or Minerva plaster brakes after surgery. Treatment of diseases: congenital cervical odontoid deformity Indication 1. The odontoid deformity causes neurological symptoms. 2. The dentate process is unstable and shifts forward or backward by more than 5 mm. 3. The dentate process is unstable and persistently aggravated. 4. The neck is persistently discomfort due to instability of the atlantoaxial axis and is not relieved by conservative treatment. Contraindications If the posterior arch of the atlas is incomplete, occipitocervical fusion should be used. Preoperative preparation 1. X-ray of lateral position and open position of the neck, showing odontoid deformity, CT examination showed odontoid deformity type. 2. MRI examination to understand the compression of the cervical spinal cord and nerve roots, further excluding syringomyelia, cervical spinal cord or cerebellar tumor. 3. Patients with neurological symptoms should first perform skull traction for 1 to 2 weeks, make it reset, restore nerve function, reduce cervical spinal irritation, and then consider surgery. 4. Bed bed training and prone position training. 5. Prefabricated one of the back and ventral plaster beds, the length from the top of the head to the middle of the double thighs. 6. 1st preoperative 1d neck 2 spinous process positioning, help to determine the location of the spinous process during surgery, and determine the appropriate line of force from the cervical lateral radiograph. Surgical procedure General anesthesia, endotracheal intubation. The sick child is placed in a prone position, and the head is placed on a special rotatable head frame or on a head support for cerebellar surgery to perform skull traction to ensure that the cervical vertebra is stabilized and then operated. Incision Make a midline incision from under the pillow to the lower end where fusion is required. 2. Reveal In the direction of the incision, 1:500,000 epinephrine was injected intradermally to help stop bleeding. Cut deep in the relatively bloodless midline, myenteric ligament, and ligament, taking care not to reveal any more areas that need to be fused to reduce the chance of spontaneous extension of the fusion. Under the periosteal anatomy, the posterior arch of the atlas and the C2 vertebral arch were exposed. The muscle and ligament attachment points of C2 were removed with a curette, and the vertebral artery was carefully dissected to the outside to prevent damage to the vertebral artery and C1 surface, within 2 cm from the midline. Vertebral plexus. When the surface of C1 is exposed, it should not exceed 1 cm outside the midline. It is generally not necessary to remove the cortical bone of the C1 and C2 surfaces. 3. Bone grafting and fixation Cut the bones containing the cortex and cancellous bone from the humerus, and climb the appropriate size of the wire from below to below the atlanto-vertebral vertebral arch. Place the bone on the surface of the C2 vertebral arch and C1 arch and under the wire. fixed. One end of the wire is then passed through the C2 spinous process and tightened with itself to secure the graft. Fielding modified wire can also be used to fix bone grafts. 4. Close the incision The wound was flushed with saline, the incision was closed in layers and the drainage tube was left in place.