Atlantoaxial transarticular screw fixation: a technique never reported from (sub-saharan) Africa?

Background: Atlantoaxial transarticular screw fixation is considered to be the “gold standard” for treating atlantoaxial instabilities. This challenging surgical procedure requires high skills and appropriate surgical armamentarium. Such conditions are rarely met in sub-Saharan Africa. After a thorough review of medical literature, we did not find a single report on atlantoaxial transarticular screwing from Africa. For this reason, we decided to report on a case we operated on at our institution. Methods: We retrospectively reviewed a case of post-traumatic acute atlantoaxial rotatory fixation (AARF) associated with C5-C6 left facet joint dislocation that we managed in our hospital with posterior atlantoaxial/transarticular screw fixation and C5-C6 lateral masses plating. Results: A 56 years old female was admitted to our service for head and cervical spine trauma following a road traffic accident. She had asymmetrical quadriplegia and urinary retention. Computed tomography (CT) scans revealed a type II atlantoaxial rotatory fixation of left atlantoaxial joint along with stage II distractive-flexion injury of left C5-C6 facet joint. Transcranial traction with Gardner-Wells tongs was performed and patient subsequently underwent surgical stabilization with modified Magerl’s technique and C5-C6 lateral masses plating. Fourthy-five days after surgery, the patient was able to walk alone without any help. Conclusions: “State-of-the art” procedures like atlantoaxial transarticular screwing are rarely performed in Sub-Saharan Africa where surgical equipment is very insufficient. But, even in these compelling conditions, such operations can be done successfully by skilled surgeons for patients’benefit.