Atlantoaxial instability is seen in patients with subluxation due to chronic rheumatoid arthritis, and nonunion of the dens due to trauma, congenital anomalies, and other conditions. Surgical intervention is indicated in cases with marked instability or myelopathy. Operative methods include anterior methods via a transoral approach and posterior methods, with the latter in general preferred. Various technical modifications of the posterior method have been devised, including the procedures of Gallie3McGraw and Rush5Salmon7Brooks and Jenkins1and Rodrigues and colleagues6among which those of McGraw and Brooks have found the widest application. However, with McGraw's procedure los of correction frequently is encountered even when halo vests and other forms of rigid external fixation are used. In the current report, we describe our new method, in which sublaminar wiring is performed first to stop anterior slippage and thereby adequately maintain the reduction position, and with which the incidence of postoperative loss of correction is significantly reduced.
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