Direct Posterior Reduction and Fixation for the Treatment of Basilar Invagination With Atlantoaxial Dislocation

Jian, Fengzeng; Chen, Zan; Wrede, Karsten H.; Samii, Madjid; Li, Feng

doi:10.1227/01.neu.0000367632.45384.5a

Cited by 149 publications

(97 citation statements)

References 30 publications

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“…39,44,59,104 Distraction may be conducted using instrumentation between the occipital bone plate/screws and C1-2 vertebral instrumentation or with distraction between C-1 and C-2 when C-1 is congenitally fused with the occiput (atlas assimilation or occipitalization of the atlas) to increase the distance between the clivus and odontoid, allowing reduction and/or reducing dislocation. 39,44,59,104 Others have used titanium spacers and bone graft to distract between the joints of C-1 and C-2 to treat basilar invagination. 29 Purely intraoperative posterior distraction techniques can be effective for reduction of mild and moderate cases of basilar invagination.…”

Section: Distraction Reductionmentioning

confidence: 99%

Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update

Dlouhy

Dahdaleh

Menezes³

et al. 2015

FOC

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The craniovertebral junction (CVJ), or the craniocervical junction (CCJ) as it is otherwise known, houses the crossroads of the CNS and is composed of the occipital bone that surrounds the foramen magnum, the atlas vertebrae, the axis vertebrae, and their associated ligaments and musculature. The musculoskeletal organization of the CVJ is unique and complex, resulting in a wide range of congenital, developmental, and acquired pathology. The refinements of the transoral approach to the CVJ by the senior author (A.H.M.) in the late 1970s revolutionized the treatment of CVJ pathology. At the same time, a physiological approach to CVJ management was adopted at the University of Iowa Hospitals and Clinics in 1977 based on the stability and motion dynamics of the CVJ and the site of encroachment, incorporating the transoral approach for irreducible ventral CVJ pathology. Since then, approaches and techniques to treat ventral CVJ lesions have evolved. In the last 40 years at University of Iowa Hospitals and Clinics, multiple approaches to the CVJ have evolved and a better understanding of CVJ pathology has been established. In addition, new reduction strategies that have diminished the need to perform ventral decompressive approaches have been developed and implemented. In this era of surgical subspecialization, to properly treat complex CVJ pathology, the CVJ specialist must be trained in skull base transoral and endoscopic endonasal approaches, pediatric and adult CVJ spine surgery, and must understand and be able to treat the complex CSF dynamics present in CVJ pathology to provide the appropriate, optimal, and tailored treatment strategy for each individual patient, both child and adult. This is a comprehensive review of the history and evolution of the transoral approaches, extended transoral approaches, endoscopie assisted transoral approaches, endoscopie endonasal approaches, and CVJ reduction strategies. Incorporating these advancements, the authors update the initial algorithm for the treatment of CVJ abnormalities first published in 1980 by the senior author.

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Section: Distraction Reductionmentioning

confidence: 99%

Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update

Dlouhy

Dahdaleh

Menezes³

et al. 2015

FOC

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“…Several reduction methods such as those of Goel, Jian, Wang, and others have been applied to make the odontoid process move downward and tilt forward. 1,6,10,11,22,25 Among them, the method of Jian is relatively simple and more familiar to us. Application of posterior reduction can effectively decompress the neuraxis and avoid the drawbacks of ventral decompression in selected cases with basilar invagination.…”

Section: Discussionmentioning

confidence: 99%

“…2,4,8,9,12,13,[16][17][18]21,23,[26][27][28][29] The other technique is posterior-only reduction, which could preserve the anatomical integrity of the craniovertebral junction and avoid the risks of anterior surgery in some cases. 1,6,10,11,22,25 In this paper we present our experience in a patient with basilar invagination treated successfully using endoscopic transnasal odontoidectomy combined with posterior reduction. To the best of our knowledge, this is the first report using the 2 techniques in 1 surgical procedure to treat basilar invagination.…”

Section: ©Aans 2013mentioning

confidence: 99%

Endoscopic transnasal odontoidectomy combined with posterior reduction to treat basilar invagination

Hu²,

Zhang³

et al. 2013

SPI

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Object Transoral microscopic odontoidectomy has been accepted as a standard procedure to treat basilar invagination over the past several decades. In recent years the emergence of new technologies, including endoscopic odontoidectomy and posterior reduction, has presented a challenge to the traditional treatment algorithm. In this article, the authors describe 1 patient with basilar invagination who was successfully treated with endoscopic transnasal odontoidectomy combined with posterior reduction. The purpose of this report is to validate the effectiveness of this treatment algorithm in selected cases and describe several operative nuances and pearls based on the authors' experience. Methods One patient with basilar invagination caused by a congenital osseous malformation underwent endoscopic transnasal odontoidectomy combined with posterior reduction in a single operative setting. The purely endoscopic transnasal odontoidectomy was first conducted with the patient supine. The favorable anatomical reduction was then achieved through a posterior approach after the patient was moved prone. Results The patient was extubated after recovery from anesthesia and allowed oral food intake the next day. No complications were noted, and the patient was discharged 4 days after the operation. Postoperative imaging demonstrated excellent decompression of the anterior cervicomedullary junction pathology. The patient was followed up for 12 months and remarkable neurological recovery was observed. Conclusions The endoscopic transnasal odontoidectomy is a better minimally invasive approach for anterior decompression and can make the posterior reduction easier because the anterior resistant force is eliminated. The subsequent posterior reduction can make decompression of the ventral side of the cervicomedullary junction more effective because the C-2 vertebral body is pushed forward. A combination of these 2 approaches has the advantages of minimally invasive access and a faster patient recovery, and thus is a valid alternative in selected cases.

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“…(5) The endoscopic transnasal approach does not need the soft palate splitting or the hard palate resection, thus minimising the risk of postoperative dysphonia or velopharyngeal insufficiency (VPI) [15,16,31]. In recent years, more aggressive posterior reduction including decompression, instrumentation, realignment and fusion has been used to treat basilar invagination, which reduced the need of anterior decompression [32][33][34][35][36]. We believe that the value of the anterior approach decompression can never be underestimated, although some patients may benefit from the posterior reduction.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic transnasal odontoidectomy to treat basilar invagination with congenital osseous malformations

Wang

Zhang

et al. 2012

Eur Spine J

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Purpose Transoral resection of the odontoid has been accepted as a standard procedure to decompress the cervicomedullary junction during the past several decades. The endoscopic transnasal odontoidectomy is emerging as a feasible surgical alternative to conventional microscopic transoral approach. In this article, we describe several operative nuances and pearls from our experience about this approach, which provided successful decompression. Methods From September 2009 to April 2010, three consecutive patients with basilar invagination, of which the etiology was congenital osseous malformations, underwent endoscopic transnasal odontoidectomy. All patients presented with myelopathy. The last two cases also received occipitocervical fixation and bone fusion during the same surgical episode to ensure stability. Results All the patients were extubated after recovery from anesthesia and allowed oral food intake the next day. Cerebrospinal fluid rhinorrhea was found in the second case and cured by continuous lumber drainage of cerebrospinal fluid. No infection was noted. The average follow-up time was more than 24 months. Remarkable neurological recovery was observed postoperative in all patients. Conclusion The endoscopic transnasal odontoidectomy is a feasible approach for anterior decompression of pathology at the cervicomedullary junction. The advantages over the standard transoral odontoidectomy include elimination of risk of tongue swelling and teeth damaging, improvement of visualization, alleviation of prolonged intubation, reduction of need for enteral tube feeding and less risk of affecting phonation. The minimally invasive access and faster recovery associated with this technique make it a valid alternative for decompression of the ventral side of the cervicomedullary junction.

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Direct Posterior Reduction and Fixation for the Treatment of Basilar Invagination With Atlantoaxial Dislocation

Abstract: The direct posterior distraction technique between occiput and C2 pedicle screws is an effective, simple, fast, and safe method for the treatment of BI with AAD. Transoral odontoidectomy and cervical traction for the treatment of BI with AAD should be reconsidered.

Cited by 149 publications

References 30 publications

Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update

Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update

Endoscopic transnasal odontoidectomy combined with posterior reduction to treat basilar invagination

Endoscopic transnasal odontoidectomy to treat basilar invagination with congenital osseous malformations

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