One-Step Fixation of Atlantoaxial Rotatory Subluxation: Technical Note and Report of Three Cases

Dahdaleh, Nader S.; Dlouhy, Brian J.; Menezes, Arnold H.

doi:10.1016/j.wneu.2012.11.040

Cited by 14 publications

(8 citation statements)

References 12 publications

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“…With recent advances in spinal instrumentation surgery, posterior fusion surgery has been performed increasingly in treatment for AAS, reportedly with good clinical outcomes (2,7,11,13,26). The procedure, however, carries a potential risk of injury to adjacent vessels such as the vertebral artery (VA), which may lead to massive intraoperative hemorrhage and even death (12).…”

Section: Introductionmentioning

confidence: 99%

Risks of In-Hospital Death and Complications After Fusion Surgery in Patients with Atlantoaxial Subluxation: Analysis of 1090 Patients Using the Japanese Diagnosis Procedure Combination Database

et al. 2015

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Section: Introductionmentioning

confidence: 99%

Risks of In-Hospital Death and Complications After Fusion Surgery in Patients with Atlantoaxial Subluxation: Analysis of 1090 Patients Using the Japanese Diagnosis Procedure Combination Database

et al. 2015

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“…This method can achieve anatomical reduction through application of substantial traction with total muscle curarization eliminating any muscular resistance under general anesthesia. Dahdaleh et al previously reported that the utility of neuromuscular blockade and intraoperative traction could overcome the counteractive retractions of the neck muscles and thus facilitated reduction of BI and chronic atlantoaxial rotatory subluxation in pediatric cases [11,12]. However, skull traction cannot achieve good results in the absence of general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of atlantoaxial subluxation by intraoperative skull traction and C1-C2 fixation

Guo

et al. 2020

BMC Musculoskelet Disord

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Background: Atlantoaxial subluxation (AAS) is a not rare abnormality between the atlas (C1) and axis (C2). For AAS patients with persistent neck pain and neurologic symptoms, surgical intervention is a good choice. Nevertheless, there were still few reports about the use of intraoperative skull traction and different fixation methods in treatment of AAS. Methods: From January 2012 to December 2018, a total of 86 cases were admitted to our hospital and diagnosed as AAS. All the patients received atlantoaxial reduction with the help of intraoperative skull traction and C1-C2 fixation. Clinical and radiological parameters were collected through chart review. Results: There were 86 cases included in this study. The mean operative time was 153.9 ± 73.9 min, and the mean amount of intraoperative blood loss was 219.1 ± 195.6 ml. 81 patients underwent posterior reduction, internal fixation and fusion. 5 patients underwent anterior release, followed by posterior internal fixation and fusion. 82 patients got satisfactory postoperative outcomes while complications occurred in 4 patients. Significant neurologic improvement was observed in these patients. Bone fusion was achieved on the midline sagittal reconstructed CT images at the latest follow-up in all these patients except 1 case. All the patients were followed up for 34.84 ± 15.86 months at average (range 12-60 months). The mean ADI value was 7.55 ± 1.67 mm at average preoperatively, and improved to 4.03 ± 1.21 mm postoperatively, and to 4.21 ± 0.99 mm at the latest follow-up. The mean A-A angle was 15.48 ± 9.82 degrees at average preoperatively, and improved to 21.61 ± 10.43 degrees postoperatively, and to 19.73 ± 8.13 degrees at the latest follow-up. The mean A-A height was 35.61 ± 7.66 mm at average preoperatively, and improved to 40.08 ± 8.5 mm postoperatively, and to 38.83 ± 6.97 mm at the latest follow-up. There were complications in 4 patients, including pedicle misplacement, pedicle screw fracture, infection and one death. Conclusion: Intraoperative skull traction can effectively facilitate the surgical procedures for ASS caused by different etiologies. Further research will be needed to investigate the safety and effectiveness of this method in the future.

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“…Prior studies evaluated the use of intraoperative CT scanning for evaluation of hardware placement in pediatric cervical spine surgery. 1,6,7,21 In an analysis of 31 pediatric patients with craniocervical instability, Karandikar et al found intraoperative CT to be beneficial in reducing the number of revision surgeries for correction of misplaced instrumentation. 21 In this study, 18 of 47 C1-2 transarticular screws were "suboptimally placed" using standard techniques.…”

Section: Discussionmentioning

confidence: 99%

“…Dahdaleh et al used intraoperative CT to evaluate for appropriate reduction of basilar invagination and atlantoaxial rotary subluxation. 6,7 Attia et al used intraoperative CT to perform reduction and fusion in patients with traumatic atlantoaxial rotary subluxation. 1 In their report, intraoperative CT was specifically used to guide C-1 lateral mass and C-2 pedicle screws.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of CT-based intraoperative 3D stereotactic image-guided navigation in the upper cervical spine of children 10 years of age or younger: initial experience

Kovanda¹,

Ansari²,

Qaiser³

et al. 2015

PED

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OBJECT Rigid screw fixation may be technically difficult in the upper cervical spine of young children. Intraoperative stereotactic navigation may potentially assist a surgeon in precise placement of screws in anatomically challenging locations. Navigation may also assist in defining abnormal anatomy. The object of this study was to evaluate the authors’ initial experience with the feasibility and accuracy of this technique, both for resection and for screw placement in the upper cervical spine in younger children. METHODS Eight consecutive pediatric patients 10 years of age or younger underwent upper cervical spine surgery aided by image-guided navigation. The demographic, surgical, and clinical data were recorded. Screw position was evaluated with either an intraoperative or immediately postoperative CT scan. RESULTS One patient underwent navigation purely for guidance of bony resection. A total of 14 navigated screws were placed in the other 7 patients, including 5 C-2 pedicle screws. All 14 screws were properly positioned, defined as the screw completely contained within the cortical bone in the expected trajectory. There were no immediate complications associated with navigation. CONCLUSIONS Image-guided navigation is feasible within the pediatric cervical spine and may be a useful surgical tool for placing screws in a patient with small, often difficult bony anatomy. The authors describe their experience with their first 8 pediatric patients who underwent navigation in cervical spine surgery. The authors highlight differences in technique compared with similar navigation in adults.

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One-Step Fixation of Atlantoaxial Rotatory Subluxation: Technical Note and Report of Three Cases

Cited by 14 publications

References 12 publications

Risks of In-Hospital Death and Complications After Fusion Surgery in Patients with Atlantoaxial Subluxation: Analysis of 1090 Patients Using the Japanese Diagnosis Procedure Combination Database

Risks of In-Hospital Death and Complications After Fusion Surgery in Patients with Atlantoaxial Subluxation: Analysis of 1090 Patients Using the Japanese Diagnosis Procedure Combination Database

Surgical treatment of atlantoaxial subluxation by intraoperative skull traction and C1-C2 fixation

Feasibility of CT-based intraoperative 3D stereotactic image-guided navigation in the upper cervical spine of children 10 years of age or younger: initial experience

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