One-step fixation of atlantoaxial rotatory subluxation: Technical note and report of three cases

Nader S. Dahdaleh, Brian J. Dlouhy, Arnold H. Menezes*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

14 Scopus citations


Objective: To describe a successful one-step intraoperative reduction of atlantoaxial rotatory subluxation (AARS) using neuromuscular blockade and intraoperative traction. Methods: While the patient was undergoing continuous somatosensory evoked potential monitoring, crown halo traction was applied under general anesthesia. A muscle relaxant was administered, and an intraoperative computed tomography scan was performed using the O-arm Surgical Imaging System in the supine position verifying adequate reduction. The patient was placed in the prone position, and a repeat image was obtained verifying persistent reduction in the position that the patient would undergo dorsal fixation. Occipitocervical fixation was then performed. Results: This technique was performed successfully in three pediatric patients with chronic AARS. There were no complications related to the procedure. Conclusions: Intraoperative traction and neuromuscular blockade achieved a one-step reduction before fixation for subacute and chronic irreducible AARS. This one-step reduction obviates preoperative traction, which is often inconvenient and not tolerated by pediatric patients. Successful reduction is also demonstrated in detail intraoperatively with three-dimensional imaging.

Original languageEnglish (US)
JournalWorld neurosurgery
Issue number6
StatePublished - Dec 1 2013


  • Atlantoaxial rotatory subluxation
  • O-arm
  • Occipitocervical fusion
  • Reduction

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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