Abstract

Background

Traumatic occipitocervical dislocation (OCD) occurs due to fatal high-energy injury. Modern screw-based constructs enable successful reduction and stabilisation. In view of this, there are no previous reports on the spontaneous remodelling of the O-C1 joint after posterior fusion. We report the first case of postoperative spontaneous remodelling and stabilisation of the O-C1 joint after traumatic OCD.

Case description: A 9-year-old girl suffered from traumatic OCD, accompanied by complete rupture of the O-C1-C2 ligamentous complex. Halo-vest fixation, and subsequently posterior fusion surgery from the occipital bone to C2, with autologous iliac crest bone graft and an allograft were performed. However, we could not achieve complete reduction of the O-C1 joint during surgery owing to extremely severe instability.

Postoperative X-ray and computed tomography scan showed incomplete reduction of the O-C1 joint. Insufficient congruity of the O-C1 joint persisted. Afterwards, gradual spontaneous remodelling of the O-C1 joint occurred, both anteriorly and posteriorly 3 months postoperatively. Solid union was achieved 6 months postoperatively. Two years later, bilateral O-C1 joints in the patient were completely reformed and restabilised by incredible vigorous remodelling. Insufficient reduction and persisting poor joint congruence after surgery for OCD was probably restabilised by further spontaneous remodelling of articular morphology in such a young patient.

Conclusions

Postoperative spontaneous remodelling of the O-C1 joint after posterior reconstruction for OCD may occur in young patients. Incomplete reduction of the O-C1 joint during surgery may be acceptable due to the possibility of postoperative bone remodelling and restabilisation.

中文翻译：

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枕颈脱位后路融合后O-C1关节的自发形态重塑

摘要

背景

创伤性枕颈脱位 (OCD) 是由于致命的高能量损伤而发生的。现代基于螺钉的结构能够成功地减少和稳定。鉴于此，以往没有关于后路融合后O-C1关节自发重塑的报道。我们报告了第一例创伤性强迫症术后 O-C1 关节自发重塑和稳定的病例。

病例描述：一名9岁女孩患有外伤性强迫症，伴有O-C1-C2韧带复合体完全断裂。进行了 Halo-vest 固定，随后进行了从枕骨到 C2 的后路融合手术，并进行了自体髂嵴骨移植和同种异体移植。然而，由于极其严重的不稳定性，我们无法在手术过程中完全复位 O-C1 关节。

术后 X 线和计算机断层扫描显示 O-C1 关节不完全复位。O-C1 关节的一致性不足仍然存在。之后，O-C1 关节逐渐自发重塑，术后 3 个月前后均发生。术后6个月牢固愈合。两年后，患者的双侧 O-C1 关节通过令人难以置信的剧烈重塑得到完全改造和重新稳定。在这样一位年轻的患者中，通过进一步自发重塑关节形态，可能会重新稳定 OCD 手术后复位不足和持续较差的关节一致性。

结论

OCD 后路重建后 O-C1 关节的术后自发重塑可能发生在年轻患者中。由于术后骨重塑和重新稳定的可能性，手术期间 O-C1 关节的不完全复位可能是可以接受的。