J Korean Fract Soc.  2007 Jan;20(1):90-93. 10.12671/jkfs.2007.20.1.90.

Old Atlantoaxial Rotary Subluxation Associated with High-riding Vertebral Arteries: Arthrodesis Using C1 Lateral Mass Screws and C2 Laminar Screws: A Case Report

  • 1Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea. ortho@hananet.net


To the best of our knowledge, there has been no domestic report on posterior atlantoaxial fusion with segmental screw fixation using C2 laminar screws and C1 lateral mass screws for atlantoaxial subluxation. We report the result of this operation performed in a patient with old atlantoaxial rotary subluxation who required posterior fusion. We chose this technique in this patient because wire fixation was not suitable due to osteoporosis, and transarticular screw fixation and use of C2 pedicle screws were not feasible due to the peculiar bony anatomy of the axis.


Old atlantoaxial rotary subluxation; Atlantoaxial segmental screw fixation; C1 lateral mass screw; C2 laminar screw

MeSH Terms

Pedicle Screws
Vertebral Artery*


  • Fig. 1 Preoperative radiographs (A, B) and a bone scan image (C) are shown. (A) Preoperative open mouth view shows obliteration of the right C1-2 facet joint (black arrowhead), which arouses suspicion of rotary subluxation or unilateral facet joint destruction. (B) On lateral view, the C1-2 area does not seem cleanly, which might be a result of facet joint destruction. (C) On bone scan, there is a hot uptake on the right C1-2 facet joint area.

  • Fig. 2 (A) Three-dimensional CT scan image shows rotary subluxation and severe osteophyte formation at the Rt C1-2 facet joint. (B, C) Sagittal reconstruction images show anomalous high-riding vertebral arteries on both sides. (D) An axial image shows small pedicles on both sides.

  • Fig. 3 Postoperative radiographs (A, B) and CT scan images (C, D) show satisfactory position of the screws.


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