【Abstract】 Objectives: To explore the clinical fea-
tures of traumatic atlantoaxial instability combined with
subaxial cervical spinal cord injury (CSCI), and to analyze
the feasibility, indication and therapeutic effects of ante-
rior-posterior approach in such cases.
Methods: From March 2004 to September 2009, 16
cases with this trauma were admitted and surgically treated
in our department. Before surgery, skull traction was
performed. Posterior atlantoaxial pedicle screw internal fixa-
tion and bone graft fusion were conducted to manage trau-
matic atlantoaxial instability . As for subaxial CSCI, anterior
cervical corpectomy or discectomy decompression, bone
grafting and internal fixation with steel plates were applied.
Results: All operations were successful. The average
operation time was 3 hours and operative blood loss 400 ml.
Satisfactory reduction of both the upper and lower cervical
spine and complete decompression were achieved. All pa-
tients were followed up for 12 to 36 months. Their clinical
symptoms were improved by various levels. The Japanese
Orthopaedic Association (JOA) scores ranged from 10
to 16 one year postoperatively, 13.95±2.06 on average
(improvement rate=70.10%). X-rays, spiral CT and MRI con-
firmed normal cervical alignments, complete decompression
and fine implants’ position. There was no breakage or loos-
ening of screws, nor exodus of titanium mesh or implanted
bone blocks. The grafted bone achieved fusion 3-6 months
postoperatively and no atlantoaxial instability was observed.
Conclusions: Traumatic atlantoaxial instability may
combine with subaxial CSCI, misdiagnosis of which should
be especially alerted and avoided. For severe cases, one
stage anterior-posterior approach to decompress the upper
and lower cervical spine, together with reposition, bone
grafting and fusion, as well as internal fixation can immedi-
ately restore the normal alignments and stability of the cer-
vical spine and effectively improve the spinal nervous
function, thus being an ideal approach.
Key words: Atlanto-axial joint; Cervical vertebrae;
Spinal injuries; Cervicoplasty