Surgical management of atlantoaxial dislocation and cervical spinal cord injury in craniopagus twins

Michael P. Wemhoff, Kevin Swong, Daphne Li, Neal Mugve, Lisa A. Gramlich, Russ P. Nockels*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


A case of cervical spinal cord injury in 12-year-old angular craniopagus twins is presented, with a description of the planning and execution of surgical treatment along with subsequent clinical outcome. The injury occurred following a fall from a standing position, resulting in quadriparesis in one of the twins. Imaging revealed severe craniocervical stenosis resulting from a C1-2 dislocation, and T2-weighted hyperintensity of the cervical spinal cord. After custom halo fixation was obtained, a posterior approach was utilized to decompress and instrument the occiput, cervical, and upper thoracic spine with intraoperative reduction of the dislocation. Early neurological improvement was noted during the acute postoperative phase, and 27 months of follow-up demonstrated intact instrumentation with continued neurological improvement to near baseline. The complexity of managing such an injury, inclusive of the surgical, anesthetic, biomechanical, and ethical considerations, is described in detail.

Original languageEnglish (US)
Pages (from-to)751-756
Number of pages6
JournalJournal of Neurosurgery: Spine
Issue number6
StatePublished - Dec 2020
Externally publishedYes


  • Atlantoaxial dislocation
  • C1-2 instability
  • Cervical spinal cord injury
  • Congenital
  • Craniocervical deformity
  • Craniopagus twins
  • Halo immobilization
  • Occipitocervicothoracic fusion

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology


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