C-arm Free O-arm Navigated Posterior Atlantoaxial Fixation in Down Syndrome: A Technical Note

Masato Tanaka, Sumeet Sonawane, Yoshihiro Fujiwara, Koji Uotani, Shinya Arataki, Taro Yamauchi, Youchen Ye, Haruo Misawa

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


The surgical treatment of pediatric atlantoaxial subluxation (AAS) in Down syndrome (DS) remains technically challenging due to radiation exposure and complications such as vertebral artery injury and nonunion. The established treatment is fixation with a C1 lateral mass screw and C2 pedicle screw (modified Goel technique). However, this technique requires fluoroscopy for C1 screw insertion. To avoid exposing the operating team to radiation we present here a new C-arm free O-arm navigated surgical procedure for pediatric AAS in DS. A 5-year-old male DS patient had neck pain and unsteady gait. Radiograms showed AAS with an atlantodental interval of 10 mm, and irreducible subluxation on extension. CT scan showed Os odontoideum and AAS. MRI demonstrated spinal cord compression between the C1 posterior arch and odontoid process. We performed a C-arm free O-arm navigated modified Goel procedure with postoperative halo-vest immobilization. At one-year follow-up, good neurological recovery and solid bone fusion were observed. The patient had no complications such as epidural hematoma, infection, or nerve or vessel injury. This novel procedure is a useful and safe technique that protects surgeons and staff from radiation risk.

Original languageEnglish
Pages (from-to)71-78
Number of pages8
JournalActa medica Okayama
Issue number1
Publication statusPublished - 2022


  • Atlantoaxial fixation
  • C-arm free
  • Down syndrome
  • Modified goel technique
  • O-arm navigation surgery

ASJC Scopus subject areas

  • General Biochemistry,Genetics and Molecular Biology


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