scholarly journals Release, reduction, and fixation of one-stage posterior approach for basilar invagination with irreducible atlantoaxial dislocation

2020 ◽  
pp. 1-14
Author(s):  
Jian Wang ◽  
Tao Xu ◽  
Lati Pu ◽  
Erdan Mai ◽  
Hailong Guo ◽  
...  
Keyword(s):  
Posterior Approach ◽  
Basilar Invagination ◽  
Atlantoaxial Dislocation ◽  
One Stage ◽  
Irreducible Atlantoaxial Dislocation

Management of pediatric patients with irreducible atlantoaxial dislocation: transoral anterior release, reduction, and fixation

2019 ◽  
Vol 24 (3) ◽  
pp. 323-329
Author(s):  
Changrong Zhu ◽  
Jianhua Wang ◽  
Zenghui Wu ◽  
Xiangyang Ma ◽  
Fuzhi Ai ◽  
...  
Keyword(s):  
Spinal Injury ◽  
Posterior Instrumentation ◽  
Basilar Invagination ◽  
Atlantoaxial Dislocation ◽  
Neurological Deficits ◽  
Os Odontoideum ◽  
Complete Control ◽  
Anterior Release ◽  
One Stage ◽  
Irreducible Atlantoaxial Dislocation

OBJECTIVEAlthough transoral atlantoaxial reduction plate (TARP) surgery has been confirmed to be safe and effective for adults who have irreducible atlantoaxial dislocation (IAAD) with or without basilar invagination or upper cervical revision surgery, it is rarely used to treat these disorders in children. The authors of this study aimed to report on the use of the anterior technique in treating pediatric IAAD.METHODSIn this retrospective study, the authors identified 8 consecutive patients with IAAD who had undergone surgical reduction at a single institution in the period between January 2011 and June 2104. The patients consisted of 5 males and 3 females. Three had os odontoideum, 2 had basilar invagination, and the other 3 experienced atlantoaxial rotatory fixed dislocation (AARFD). They were all treated using transoral anterior release, reduction, and fusion with the TARP. Preoperative and postoperative CT scans and MR images were obtained. American Spinal Injury Association (ASIA) Impairment Scale grades were determined.RESULTSAll symptoms were relieved in all 8 patients but to varying degrees. Intraoperative loose reduction and fixation of C1–2 were achieved in one stage. The 4 patients with preoperative neurological deficits were significantly improved after surgery, and their latest follow-ups indicated that their ASIA Impairment Scale grades had improved to E. Postoperative pneumonia occurred in 1 patient but was under complete control after anti-infective therapy and fiber optic–guided sputum suction.CONCLUSIONSOne-stage transoral anterior release, reduction, and fixation is an effective, reliable, and safe means of treating pediatric IAAD. The midterm clinical results are satisfactory, with the technique eliminating the need for interval traction and/or second-stage posterior instrumentation and fusion.

scholarly journals Surgical treatment for basilar invagination with irreducible atlantoaxial dislocation: transoral atlantoaxial reduction plate fixation vs occipitocervical fixation

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaobao Zou ◽  
Bieping Ouyang ◽  
Haozhi Yang ◽  
Binbin Wang ◽  
Su Ge ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Early Stage ◽  
Plate Fixation ◽  
Japanese Orthopaedic Association ◽  
Odontoid Process ◽  
Basilar Invagination ◽  
Atlantoaxial Dislocation ◽  
Clinical Effects ◽  
Occipitocervical Fixation ◽  
Irreducible Atlantoaxial Dislocation

Abstract Background Transoral atlantoaxial reduction plate (TARP) fixation or occipitocervical fixation (OF) is an effective treatment for basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD). But, all current clinical studies involved a single surgical procedure. The clinical effects of TARP and OF operation for BI with IAAD have yet to be compared. We therefore present this report to compare the treatment of TARP and OF procedure for BI with IAAD. Methods Fifty-six patients with BI with IAAD who underwent TARP or OF operation from June 2011 to June 2017 were retrospectively analyzed. Among these, 35 patients underwent TARP operation (TARP group), and 21 patients underwent OF operation (OF group). We compared the difference of clinical, radiological, and surgical outcomes between the TARP and OF groups postoperatively. Results Compared with OF group, the operative time and blood loss in TARP group were lower. There was no statistical difference in the atlantodental interval (ADI), clivus canal angle (CCA), cervicomedullary angle (CMA), distance between the top of the odontoid process and the Chamberlain line (CL) and Japanese Orthopaedic Association (JOA) score between the TARP and OF groups preoperatively, but the improvements of these parameters in the TARP group were superior to those in the OF group postoperatively. The fusion rates were higher in the TARP group than those in the OF group at the early stage postoperatively. Conclusions TARP and OF operations are effective surgical treatment for BI with IAAD, but the performance of reduction and decompression and earlier bone fusion rates of TARP procedure are superior to those of OF.

scholarly journals Transoral intraarticular cage distraction and C-JAWS fixation for revision of basilar invagination with irreducible atlantoaxial dislocation

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaobao Zou ◽  
Binbin Wang ◽  
Haozhi Yang ◽  
Su Ge ◽  
Bieping Ouyang ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Odontoid Process ◽  
Basilar Invagination ◽  
Atlantoaxial Dislocation ◽  
Atlantoaxial Instability ◽  
Cervical Cord ◽  
Atlantoaxial Joint ◽  
Japanese Orthopedic Association ◽  
Satisfactory Outcome ◽  
Irreducible Atlantoaxial Dislocation

Abstract Background The revision surgery of basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD) after a previous occipitocervical fusion (OCF) is challenging. Transoral revision surgery has more advantages than a combined anterior and posterior approach in addressing this pathology. The C-JAWS is a cervical compressive staple that has been used in the lower cervical spine with many advantages. Up to now, there is no report on the application of C-JAWS in the atlantoaxial joint. We therefore present this report to investigate the clinical outcomes of transoral intraarticular cage distraction and C-JAWS fixation for revision of BI with IAAD. Methods From June 2011 to June 2015, 9 patients with BI and IAAD were revised by this technique after previous posterior OCF in our department. Plain cervical radiographs, computed tomographic scans and magnetic resonance imaging were obtained pre- and postoperatively to assess the degree of atlantoaxial dislocation and compression of the cervical cord. The Japanese Orthopedic Association (JOA) score was used to evaluate the neurological function. Results The revision surgeries were successfully performed in all patients. The average follow-up duration was 18.9 ± 7.3 months (range 9–30 months). The postoperative atlas-dens interval (ADI), cervicomedullary angle (CMA), distance between the top of the odontoid process and the Chamberlain line (CL) and JOA score were significantly improved in all patients (P < 0.05). Bony fusion was achieved after 3–9 months in all cases. No patients developed recurrent atlantoaxial instability. Conclusions Transoral revision surgery by intraarticular cage distraction and C-JAWS fixation could provide a satisfactory outcome for BI with IAAD after a previous unsuccessful posterior operation.

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