Hybrid and double insurance atlantoaxial facetal fixation

The authors report a case of a 19-year-old female patient having basilar invagination with complex musculoskeletal abnormalities wherein atlantoaxial fixation was done with a combination of Goel and Magerl techniques on a single articulation on one side and two transarticular screws (Magerl technique) were deployed on the contralateral side articulation. The combination of Goel and Magerl techniques used in a novel fashion resulted in strong fixation and provided an environment for bone fusion. The special joint architecture and location of facet of atlas anterior and rostral to the facet of axis in the form of facetal-spondyloptosis were used to advantage as it provided a direct screw trajectory for transarticular screw insertion. The patient recovered after surgery in her neurological function. Craniovertebral junction realignment could be observed. Solid bone fusion was observed after 8 months of the surgical procedure.