Occipitocervical fixation using Ransford loop for neglected posttraumatic odontoid fracture with atlantoaxial dislocation: A technical note
- Department of Surgery, Faculty of Medical, Universitas Kristen Indonesia, Jakarta, Indonesia.
DOI:10.25259/SNI_523_2019Copyright: © 2019 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Robert Sinurat. Occipitocervical fixation using Ransford loop for neglected posttraumatic odontoid fracture with atlantoaxial dislocation: A technical note. 15-Nov-2019;10:218
How to cite this URL: Robert Sinurat. Occipitocervical fixation using Ransford loop for neglected posttraumatic odontoid fracture with atlantoaxial dislocation: A technical note. 15-Nov-2019;10:218. Available from: http://surgicalneurologyint.com/surgicalint-articles/9752/
Background: To relieve the onset of new clinical symptoms, it is important to recognize and treat previously neglected odontoid fractures. However, many hospitals in developing countries do not have the equipment or surgical expertise to adequately manage these lesions.
Case Description: A 31-year-old male presented with paresthesias/quadriparesis attributed to an accident sustained 6 months earlier. The cervical magnetic resonance image revealed atlantoaxial subluxation type 2. Following a laminectomy and occipitocervical fusion with a Ransford loop, the patient’s symptoms significantly improved.
Conclusion: Straight forward laminectomy and occipitocervical fusion with a Ransford loop may adequately treat selected cases of neglected atlantoaxial subluxation in a developing country.
Keywords: Atlantoaxial subluxation, Equipment, Stabilization
About 10–20% of cervical fractures involve the odontoid. Type 2 odontoid fractures typically do not heal well without surgery.[
Six-month duration following a motorbike accident, a 31-year-old male presented with neck pain, paresthesias, quadriparesis, and bilateral ankle clonus. Upper extremity (3/5) and lower extremity strength (4/5) were compromised. The cervical magnetic resonance image showed atlantoaxial subluxation type 2©, with an increased atlantodens interval (ADI), a decreased posterior ADI, and an increased interspinous distance.[
An incision was started from the occiput to C7. The posterior ring of C1 was drilled 1 cm lateral to the midline on both sides; additionally, a laminectomy was performed involving the upper part of the lamina of C2 bilaterally. Two small burr holes were placed in the occipital region; a Ransford loop affixed to the occipital bone using 1.5 mm wires. Similarly, the lamina of C2-C4 was fixed using 1.5 mm sublaminar wires. The patient was discharged on postoperative day 7 without any changes in his neurological status. The postoperative X-ray showed that the Ransford loop had remained in good position [
Poorly managed odontoid fractures are a common problem in underdeveloped countries due to many factors, for example, socioeconomic problems, overlooked diagnoses, and poor access to health care.[
Selected patients with neglected odontoid type 2 fractures with atlantoaxial dislocation type C can be managed utilizing a simple laminectomy decompression and occipitocervical stabilization using Ransford loops and wire.
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