scholarly journals Surgical strategies for the treatment of os odontoideum with atlantoaxial dislocation

2018 ◽  
Vol 28 (2) ◽  
pp. 131-139 ◽  
Author(s):  
Xinghuo Wu ◽  
Kirkham B. Wood ◽  
Yong Gao ◽  
Shuai Li ◽  
Jing Wang ◽  
...  
Keyword(s):  
Atlantoaxial Dislocation ◽  
Posterior Fusion ◽  
Ct Scans ◽  
Os Odontoideum ◽  
Posterior Fixation ◽  
Mr Images ◽  
Single Level ◽  
Irreducible Atlantoaxial Dislocation ◽  
Screw Breakage ◽  
Transoral Decompression

OBJECTIVEThis study aimed to compare the clinical results of using posterior fixation and fusion with or without anterior decompression to treat os odontoideum with atlantoaxial dislocation.METHODSTwenty-five consecutive patients with os odontoideum were included in this study. Sixteen patients with reducible atlantoaxial dislocation were treated by single-level posterior fusion and stabilization; the other 9 were treated with posterior fusion and stabilization combined with transoral decompression. Pre- and postoperative CT scans and MR images were obtained.RESULTSTwenty-four patients were followed for 24–54 months (average 36.5 months). Postoperative CT scans indicated that all pedicle screws were placed satisfactorily except in 2 cases, in which the screws slightly penetrated the transverse foramen. Postoperative MR images demonstrated that sufficient decompression of the spinal cord was obtained in all patients. Complications included 1 case each of pedicle screw breakage, pharynx ulcer, and persistent pharynx discomfort. Statistical analysis of all cases revealed that mean Japanese Orthopaedic Association scores improved from a preoperative score of 10.2 (range 7–13) to a postoperative score of 15.6 (range 11–18).CONCLUSIONSPatients who have os odontoideum with a reducible atlantoaxial dislocation can be effectively treated with single-level posterior fusion and stabilization. Combined transoral decompression and posterior fusion and stabilization is recommended for those with irreducible atlantoaxial dislocation.

scholarly journals A Radiological Comparison of Anterior Fusion Rates in Anterior Lumbar Interbody Fusion

2012 ◽  
Vol 2 (4) ◽  
pp. 195-206 ◽  
Author(s):  
M. J. H. McCarthy ◽  
L. Ng ◽  
G. Vermeersch ◽  
D. Chan
Keyword(s):  
Pedicle Screw ◽  
Interbody Fusion ◽  
Posterior Instrumentation ◽  
Anterior Lumbar Interbody Fusion ◽  
Posterior Fusion ◽  
Posterior Fixation ◽  
Anterior Fusion ◽  
Lumbar Interbody Fusion ◽  
Anterior Surgery ◽  
Single Level

Aim To compare anterior fusion in standalone anterior lumbar interbody fusion (ALIF) using cage and screw constructs and anterior cage–alone constructs with posterior pedicle screw supplementation but without posterior fusion. Methods Eighty-five patients underwent single- or two-level ALIF procedure for degenerative disk disease or lytic spondylolisthesis (SPL). Posterior instrumentation was performed without posterior fusion in all cases of lytic SPL and when the anterior cage used did not have anterior screw through cage fixation. Results Seventy (82%) patients had adequate radiological follow-up at a mean of 19 months. Forty patients had anterior surgery alone (24 single level and 16 two levels) and 30 had front-back surgery (15 single level and 15 two levels). Anterior locked pseudarthrosis was only seen in the anterior surgery–alone group when using the STALIF cage (Surgicraft, Worcestershire, UK) (37 patients). This occurred in five of the single-level surgeries (5/22) and nine of the two-level surgeries (9/15). Fusion was achieved in 100% of the front-back group and only 65% (26/40) of the anterior surgery–alone group. Conclusion Posterior pedicle screw supplementation without posterolateral fusion improves the fusion rate of ALIF when using anterior cage and screw constructs. We would recommend supplementary posterior fixation especially in cases where more than one level is being operated.

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 Comprehensive drilling of the C1–2 facets to achieve direct posterior reduction in irreducible atlantoaxial dislocation

2015 ◽  
Vol 23 (3) ◽  
pp. 294-302 ◽  
Author(s):  
Pravin Salunke ◽  
Sushanta K. Sahoo ◽  
Arsikere N. Deepak ◽  
Mandeep S. Ghuman ◽  
Niranjan K. Khandelwal
Keyword(s):  
Management Strategies ◽  
Atlantoaxial Dislocation ◽  
The Other ◽  
Current Management ◽  
Effective Technique ◽  
Vertebral Arteries ◽  
Irreducible Atlantoaxial Dislocation ◽  
Facet Orientation ◽  
Transoral Decompression ◽  
Graft Subsidence

OBJECT The cause of irreducibility in irreducible atlantoaxial dislocation (AAD) appears to be the orientation of the C1–2 facets. The current management strategies for irreducible AAD are directed at removing the cause of irreducibility followed by fusion, rather than transoral decompression and posterior fusion. The technique described in this paper addresses C1–2 facet mobilization by facetectomies to aid intraoperative manipulation. METHODS Using this technique, reduction was achieved in 19 patients with congenital irreducible AAD treated between January 2011 and December 2013. The C1–2 joints were studied preoperatively, and particular attention was paid to the facet orientation. Intraoperatively, oblique C1–2 joints were opened widely, and extensive drilling of the facets was performed to make them close to flat and parallel to each other, converting an irreducible AAD to a reducible one. Anomalous vertebral arteries (VAs) were addressed appropriately. Further reduction was then achieved after vertical distraction and joint manipulation. RESULTS Adequate facet drilling was achieved in all but 2 patients, due to VA injury in 1 patient and an acute sagittal angle operated on 2 years previously in the other patient. Complete reduction could be achieved in 17 patients and partial in the remaining 2. All patients showed clinical improvement. Two patients showed partial redislocation due to graft subsidence. The fusion rates were excellent. CONCLUSIONS Comprehensive drilling of the C1–2 facets appears to be a logical and effective technique for achieving direct posterior reduction in irreducible AAD. The extensive drilling makes large surfaces raw, increasing fusion rates.

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