Open Reduction of Irreducible Atlantoaxial Dislocation by Transoral Anterior Atlantoaxial Release and Posterior Internal Fixation

Wang, Chao; Yan, Ming; Zhou, Hai; Wang, Sheng Lin; Dang, Gengting

doi:10.1097/01.brs.0000217686.80327.e4

Cited by 186 publications

(151 citation statements)

References 22 publications

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“…Various congenital osseous anomalies at the craniocervical junction have been reported [11][12][13][14][15][16][17][18][19][20][21]. In the current study, the congenital lesions include os odontoideum, occipitalization of the atlas, congenital C2-3 fusion, congenital atlantoaxial subluxation, congenital basilar invagination and combined anomalies.…”

Section: Discussionmentioning

confidence: 75%

A retrospective study of congenital osseous anomalies at the craniocervical junction treated by occipitocervical plate-rod systems

et al. 2012

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Purpose To evaluate the effectiveness of posterior occipitocervical reconstruction using the anchors of cervical pedicle screws and plate-rod systems for patients with congenital osseous anomalies at the craniocervical junction. Methods Twenty patients with congenital osseous lesions who underwent posterior occipitocervical fusion using the anchors of cervical pedicle screws and plate-rod systems for reduction and fixation from 1996 to 2009 were reviewed. The lesions included os odontoideum, occipitalization of the atlas, congenital C2-3 fusion, congenital atlantoaxial subluxation, congenital basilar invagination and combined anomalies. The clinical assessment and the measurements of the images were performed preoperatively, postoperatively and at most recent follow-up. Results The combined deformity of flexion of the occipitoatlantoaxial complex and invagination of the odontoid process associated with congenital osseous lesions at the craniocervical junction was corrected by application of combined forces of extension and distraction between the occiput and the cervical pedicle screws. Preoperative myelopathy improved in 94.7 % patients. The mean Ranawat value, Redlund-Johnnell value, atlantodental distance, occiput (O)-C2 angle, and C2-C7 lordosis angle improved postoperatively and was sustained at most recent follow-up. The mean cervicomedullary angle improved from 129.3°preoperatively to 153.3°postoperatively. The mean range of motion at the lower adjacent motion segment remained unchanged at most recent follow-up. The fusion rate was 95 %. Conclusions The results of the present study indicate that posterior occipitocervical reconstruction using the anchors of cervical pedicle screws and plate-rod systems is an effective technique for treatment of deformities and/or instability caused by congenital osseous anomalies at the craniocervical junction.

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Section: Discussionmentioning

confidence: 75%

A retrospective study of congenital osseous anomalies at the craniocervical junction treated by occipitocervical plate-rod systems

et al. 2012

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“…A meaningful number of subtypes of C2-fractures exists where complete reduction, normal C1-2 rotation and a physiological anatomy is difficult to restore [1,10,11,34,42,43,71,82]. Likewise, a non-anatomical posttreatment C2-alignment, resembling a malunion, can cause significant symptoms even indicating fusion C1-2 [13,26,30,42,47,51,52,67,70,71,78,79] as it had to be done in one of our cases (Fig. 3), two others being scheduled (Fig.…”

Section: Malunion Of C2mentioning

confidence: 88%

C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes

et al. 2009

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Knowledge on the outcome of C2-fractures is founded on heterogenous samples with cross-sectional outcome assessment focusing on union rates, complications and technical concerns related to surgical treatment. Reproducible clinical and functional outcome assessments are scant. Validated generic and disease specific outcome measures were rarely applied. Therefore, the aim of the current study is to investigate the radiographic, functional and clinical outcome of a patient sample with C2-fractures. Out of a consecutive series of 121 patients with C2 fractures, 44 met strict inclusion criteria and 35 patients with C2-fractures treated either nonsurgically or surgically with motion-preserving techniques were surveyed. Outcome analysis included validated measures (SF-36, NPDI, CSOQ), and a functional CT-scanning protocol for the evaluation of C1-2 rotation and alignment. Mean followup was 64 months and mean age of patients was 52 years. Classification of C2-fractures at injury was performed using a detailed morphological description: 24 patients had odontoid fractures type II or III, 18 patients had fracture patterns involving the vertebral body and 11 included a dislocated or a burst lateral mass fracture. Thirty-one percent of patients were treated with a halo, 34% with a Philadelphia collar and 34% had anterior odontoid screw fixation. At follow-up mean atlantoaxial rotation in left and right head position was 20.2°and 20.6°, respectively. According to the classification system of posttreatment C2-alignment established by our group in part I of the C2-fracture study project, mean malunion score was 2.8 points. In 49% of patients the fractures healed in anatomical shape or with mild malalignment. In 51% fractures healed with moderate or severe malalignment. Self-rated outcome was excellent or good in 65% of patients and moderate or poor in 35%. The raw data of varying nuances allow for comparison in future benchmark studies and metaanalysis. Detailed investigation of C2-fracture morphology, posttreatment C2-alignment and atlantoaxial rotation allowed a unique outcome analysis that focused on the identification of risk factors for poor outcome and the interdependencies of outcome variables that should be addressed in studies on C2-fractures. We recognized that reduced rotation of C1-2 per se was not a concern for the patients. However, patients with worse clinical outcomes had reduced total neck rotation and rotation C1-2. In turn, C2-fractures, especially fractures affecting the lateral mass that healed with atlantoaxial deformity and malunion, had higher incidence of atlantoaxial degeneration and osteoarthritis. Patients with increased severity of C2-malunion and Electronic supplementary material The online version of this article

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“…The reduction can be maintained and further achieved by posterior fixation. In Wang's series of 33 IAAD cases [9], 26 (79%) obtained complete anatomical reduction. Some authors reported similar result but with anterior release and anterior fixation.…”

Section: Anterior Reductionmentioning

confidence: 97%

“…Without early intervention, instability at this segment may progress to dislocation. Dislocations that can be reduced by using skull traction are referred to as reducible atlantoaxial dislocations, while those dislocations that are unable to be reduced with skeletal traction, even with the assistance of general anesthesia and complete muscle relaxation, are referred to as fixed or irreducible atlantoaxial dislocation (IAAD) [9].…”

Section: History Diagnostic Differential Diagnosis Epidemiologymentioning

confidence: 99%

“…The treatment strategy in AAD cases with syringomyelia should emphasize reduction of the dislocation and stabilization of the atlantoaxial joint. Although, IAAD is referred to as irreducible, reduction can be obtained in most cases [9]. Based on his experience with 5300 cases, Menezes [6] provided a decision tree for treatment with reducibility as the goal.…”

Section: Reductionmentioning

confidence: 99%

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Syringomyelia with irreducible atlantoaxial dislocation, basilar invagination and Chiari I malformation

Wang

Yan

et al. 2009

Eur Spine J

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A 27-year-old woman presented with bilateral weakness of her all extremities for 5 years. She had a spastic gait and was unable to ambulate without assistance. Neurologic examination revealed increased deep tendon reflexes and positive pathologic reflexes. Radiographs showed occipitalization of the atlas, C2-C3 congenital fusion and fixed atlantoaxial dislocation with an atlanto-dental interval of 10 mm. MRI demonstrated cervicomedullary junction (CMJ) compression from the odontoid, a Chiari type I malformation, and syringomyelia extending from the foramen magnum to C5. The patient underwent transoral atlantoaxial release followed by posterior internal fixation from the occiput to the axis, which resulted in a significant improvement in motor function in all extremities. Postoperative images showed anatomical reduction of the atlantoaxial joint. However, an MRI performed 8 days following surgery showed a new retro-odontoid pannus had developed that was compressing the spinal cord at CMJ. A follow-up CT scan performed at 6 months post-operatively demonstrated a solid bony fusion between the occiput and C2, while an MRI at that time showed complete resolution of the retro-odontoid soft tissue mass with correction of the Chiari I malformation, and resolution of the syringomyelia. Final follow-up at 2-years revealed an excellent clinical outcome.Keywords Syringomyelia Á Irreducible atlantoaxial dislocation Á Basilar invagination Á Surgery Á Transoral release Case presentationA 27-year-old woman presented with a 5-year history of progressive weakness and numbness that began in her right extremities. Her symptoms progressed rapidly for the first year and eventually her entire right side became involved. When admitted, she complained of an unsteady gait requiring an assistive device to ambulate, and lacked coordination in her hands (impossible to button up her shirt). Neurologic examination of the lower extremities revealed normal sensation to light touch, pain and temperature, while sensory dysfunction of the upper limbs was present. Symmetrical hyperreflexia, as well as positive Hoffman's and Babinski signs were present bilaterally. Weakness was present on both sides, with the right side being more severe. Her gait was wide-based, spastic, and unsteady. She also had limited range of motion on cervical

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Open Reduction of Irreducible Atlantoaxial Dislocation by Transoral Anterior Atlantoaxial Release and Posterior Internal Fixation

Cited by 186 publications

References 22 publications

A retrospective study of congenital osseous anomalies at the craniocervical junction treated by occipitocervical plate-rod systems

A retrospective study of congenital osseous anomalies at the craniocervical junction treated by occipitocervical plate-rod systems

C2-fractures: part II. A morphometrical analysis of computerized atlantoaxial motion, anatomical alignment and related clinical outcomes

Syringomyelia with irreducible atlantoaxial dislocation, basilar invagination and Chiari I malformation

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