MS Moon, WT Choi
Spine Center, Sun General Hospital, Chung-Ku, Taejon, Korea

YW Moon
Department of Orthopedics, Sam-Sung Medical Center, Seoul, Korea

JL Moon
Department of Rehabilitation Medicine, Catholic University of Korea, Seoul, Korea

SS Kim
Moon-Kim’s Institute of Orthopedic Research, Seoul, Korea

PURPOSE. To assess the effectiveness of Brooks’ posterior stabilisation and fusion for the unstable atlantoaxial joint due to congenital dysplastic dens and trauma.

METHODS. We retrospectively studied records of 54 patients (36 males and 18 females; age range, 3–58 years) who underwent Brooks’ posterior stabilisation procedure between March 1975 and December 1999, at the Catholic University of Korea Medical Center and Dong-Shin General Hospital, Seoul. A single- atranded Kirschner wire was used to stabilise the first 19 cases (thin wires in 12 cases and thick wires in 7), and double-stranded wires were used in the next 35 cases (thin wires in 4 cases and thick wires in 31). After surgery, patients were immobilised in bed with light Halter traction of the head, followed by cervical bracing.

RESULTS. Fusion was observed by X-ray postoperatively at 15 weeks in 48 patients. Reduction was achieved in 3 luxation cases (including the single case of rotatory fixation). Brooks’ fusion failed in 4 patients with dens fractures and 2 with dens anomaly. Four dens fractures in cases of successful Brooks’ fusion in Brooks’ fusion did not unite. Wire failure occurred in 4 cases of thin single-stranded wire fixation, namely, 2 cases of dens fractures and 2 of dens anomaly.

CONCLUSION. Brooks’ procedure is safe and has a high fusion rate when double-stranded strong wire fixation of the atlantoaxial joint is combined with meticulous bone grafting and subsequent cervical bracing.

Keywords: atlantoaxial; Brooks; instability; posterior; stabilization