Transoral atlanto-axial plate fixation in the treatment of a malunited dens fracture and secondary atlanto-axial instability

Introduction: A case of a 22-year-old patient with a malunited dens fractur e and secondary atlantoaxial instability is presented. The significant narr owing of the spinal canal due to the atlanto-axial instability was associat ed with anterior myelon compression and neurological deficit. Methods: A tr ansoral approach with odontoid resection and anterior atlanto-axial plate f ixation was performed. With this technique the atlanto-axial subluxation wa s reduced and the myelon was decompressed. Results: The postoperative cours e was uneventful. The follow-up showed a complete remission of the neurolog ical deficit and a bony fusion of the atlanto-axial joints. Conclusions: Th e presented case illustrates the importance of an accurate initial diagnosi s of the degree of instability and the need for short-term follow-up examin ations. If atlanto-axial pseudarthrosis or malunion with anterior spinal co rd compression occurs, a transoral procedure with odontoid resection and at lanto-axial plate fixation seems to be an excellent salvage procedure.