Journal
JOURNAL OF NEUROSURGERY-SPINE
Volume 33, Issue 6, Pages 751-756Publisher
AMER ASSOC NEUROLOGICAL SURGEONS
DOI: 10.3171/2020.5.SPINE20537
Keywords
craniopagus twins; atlantoaxial dislocation; C1-2 instability; halo immobilization; cervical spinal cord injury; craniocervical deformity; occipitocervicothoracic fusion; congenital
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A case of cervical spinal cord injury in 12-year-old angular craniopagus twins is presented, with a description of the planning and execution of surgical treatment along with subsequent clinical outcome. The injury occurred following a fall from a standing position, resulting in quadriparesis in one of the twins. Imaging revealed severe craniocervical stenosis resulting from a C1-2 dislocation, and T2-weighted hyperintensity of the cervical spinal cord. After custom halo fixation was obtained, a posterior approach was utilized to decompress and instrument the occiput, cervical, and upper thoracic spine with intraoperative reduction of the dislocation. Early neurological improvement was noted during the acute postoperative phase, and 27 months of follow-up demonstrated intact instrumentation with continued neurological improvement to near baseline. The complexity of managing such an injury, inclusive of the surgical, anesthetic, biomechanical, and ethical considerations, is described in detail.
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