Post atlantoaxial fusion for unilateral cleft of atlas posterior arch associated with os odontoideum: case report and technique note

Yang, Jian; Ni, Bin; Yan, Wangjun; Zhou, Fang; Chen, Jinshui

doi:10.1007/s00586-011-1693-x

Cited by 5 publications

(5 citation statements)

References 25 publications

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“…In order to increase the stability, Magerl and Seeman added transarticular C1-C2 screws, which gained wide acceptance with or without posterior laminar wiring and bone grafting. This procedure showed high fusion rates up to 100% [6,7,[16][17][18][19][20]. Although the high primary stability provided by PTS fixation meant that it was favored over sublaminar wire-based techniques, complications such as misplacement of the screws with injury to the vertebral artery and spinal cord highlight its potential risks.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive anterior transarticular screw fixation and microendoscopic bone graft for atlantoaxial instability

et al. 2012

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Purpose Even though transarticular screw (TAS) fixation has been commonly used for posterior C1-C2 arthrodesis in both traumatic and non-traumatic lesions, anterior TAS fixation C1-2 is a less invasive technique as compared with posterior TAS which produces significant soft tissue injury, and there were few reports on percutaneous anterior TAS fixation and microendoscopic bone graft for atlantoaxial instability. The goals of our study were to describe and evaluate a new technique for anterior TAS fixation of the atlantoaxial joints for traumatic atlantoaxial instability by analyzing radiographic and clinical outcomes. Methods This was a retrospective study of seven consecutive patients with C1-C2 instability due to upper cervical injury treated by a minimally invasive procedure from May 2007 to August 2009. Bilateral anterior TAS were inserted by the percutaneous approach under Iso-C3D fluoroscopic control. The atlantoaxial joint space was prepared for morselized autogenous bone graft under microendoscopy. The data for analysis included time after the injuries, operating time, intraoperative blood loss, X-ray exposure time, clinical results, and complications. Radiographic evaluation included the assessment of atlantoaxial fusion rate and placement of TAS. Bone fusion of the atlantoaxial joints was assessed by flexion extension lateral radiographs and 1-mm thin-slice computed tomography images as radiographic results. Clinical assessment was done by analyzing the recovery state of clinical presentation from the preoperative period to the last follow-up and by evaluating complications. Results A total of 14 screws were placed correctly. The atlantoaxial solid fusion without screw failure was confirmed by CT scan in seven cases after a mean follow-up of 27.5 months (range 18-45 months). All patients with associated clinical presentation made a recovery without neurologic sequelae. Postoperative dysphagia occurred and disappeared in two cases within 5 days after surgery. There were no other complications during the follow-up period. Conclusions Percutaneous anterior TAS fixation and microendoscopic bone graft could be an option for achieving C1-C2 stabilization with several potential advantages such as less tissue trauma and better accuracy. Bilateral TAS fixation and morselized autograft affords effective fixation and solid fusion by a minimally invasive approach.

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Section: Discussionmentioning

confidence: 99%

Minimally invasive anterior transarticular screw fixation and microendoscopic bone graft for atlantoaxial instability

et al. 2012

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“…[37][38][39] The presence of OO in a setting of some segmental disorders of the spine, such as Klippel-Feil, bipartite atlas, hypertrophy of anterior arch of atlas, aplasia of the anterior arch of the atlas, split atlas, the absence of the posterior arch of the atlas, the hypertrophy of the posterior arch of the atlas, and basilar invagination have been regarded as being in favor of congenital etiology as well. 39 The last report of this kind was released in 2011 by Yang et al, 40 who presented the combination of OO with unilateral cleft of the posterior arch of atlas in a 34year-old woman. In a series of 44 patients with OO reported by Dai et al, 4 in 18 cases coexistence of OO with various congenital anomalies of the cervical spine, including Klippel-Feil syndrome, occipitalization of C1, basilar invagination, and hypertrophy of the anterior arch of the atlas, were demonstrated.…”

Section: Congenital Theorymentioning

confidence: 99%

Atlantoaxial Subluxation Secondary to Unstable Os Odontoideum in a Patient With Arrested Hydrocephalus Due to Congenital Aqueductal Stenosis: A Case Report

Rahimizadeh¹,

Williamson

Rahimizadeh

et al. 2018

Int J Spine Surg

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Background: In a small percentage of children born with congenital hydrocephalus, enlargement of the head and the presence of ventriculomegaly may halt and ultimately stabilize the condition designated as arrested hydrocephalus. Arrested hydrocephalus in children is typically due to congenital aqueduct stenosis, which can be described appropriately as a stasis existing within the channel between the third and fourth ventricles. Os odontoideum (OO) is an uncommonly occurring pathology at the craniovertebral junction. Although the clinical and radiologic features of its existence and the therapeutic options for its pathology have been widely discussed within the medical literature, its true etiology has been a source of divisive debate, proposing both a traumatic as well as a congenital mechanism. The etiology of OO has been heartily debated in the literature for several years as well. Most authors have come to support a posttraumatic causality. However, strong evidence exists to support a congenital origin to this rarely observed malformation. Methods: Within this case study we present a 24-year-old woman with atlantoaxial subluxation that exists secondary to an orthotropic OO. The patient had a history of arrested hydrocephalus due to congenital aqueductal stenosis beginning in early childhood. She presented with normal intelligence and was neurologically without deficits before the occurrence of an atlantoaxial dislocation. Unfortunately, the pathology was initially misdiagnosed as a decompensation state of the arrested hydrocephalus, and after 8 months the patient became wheelchair bound. Following this unfortunate event the correct diagnosis was ultimately uncovered. Subsequently a C2-1 instrumentation procedure resulted in excellent alignment and fusion. Conclusions: To the best of our knowledge, this is the first example of an aqueduct stenosis in the setting of an existing OO, a combination that might be another clue in favor of a congenital etiology.

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“…34, 41 Yang et al reported the introduction of an unilateral cleft of the posterior arch of the atlas in a 34-year-old female with OO. 74 Furthermore, in acute cervical injuries, distinguishing OO from a dens fracture can be critical, as many characteristics of OO may overlap with a healed dens fracture. The smooth, well-corticated, sclerotic margins and round or oval shape as observed can help distinguish this pathological condition from non-corticated dens fractures with irregular margins of an acute type II odontoid fracture.…”

Section: Symptomatic Patientsmentioning

confidence: 99%

“…An interesting option instead of lateral mass screw is the use of C1 laminar hook under certain circumstances, where the use of lateral mass screw on one or both sides is not feasible (Figure 11). 74 …”

Section: Management Of Reducible Atlantoaxial Instability In Oomentioning

confidence: 99%

“…73 In 2011, Yang et al reported the case study of a 34-year-old female with unilateral cleft of the posterior arch of the atlas in association with OO. 74 Among other evidences supporting the congenital origin of OO, might be the observations recorded from cephalometric radiographs through experimental studies, undertaken for the evaluation of dental anomalies in children. [75][76][77] However, this theory has been questioned on account of the location of the neurocentral synchondrosis below the level of the superior articulating facet, whereas the gap in OO is frequently located above the plane of the superior articulating facet.…”

Section: Introductionmentioning

confidence: 99%

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Os Odontoideum: Review Article

Rahimizadeh¹

2017

Orthop Res Traumatol Open J

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Os odontoideum (OO) is defined as an ossicle with circumferential smooth margins and no osseous continuity with the body of axis. While the size of the ossicle is variable, it has a smooth surface, therefore, the cause of this condition has been presumed to be both congenital and traumatic. The possible cause of this condition has been implicated in its underlying etiology. However, patients with this condition may be asymptomatic or may be symptomatic of a variety of neurological deficits and vascular dysfunctions. The treatment of both the asymptomatic and symptomatic characteristics of this condition has undergone changes over the past few decades. The most challenging issue encountered is the management of OO with irreducible atlantoaxial dislocation. This outlines the objective of our discussion to examine the aforementioned subject extensively and review the appropriate potential strategies for the treatment of this condition.

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Post atlantoaxial fusion for unilateral cleft of atlas posterior arch associated with os odontoideum: case report and technique note

Cited by 5 publications

References 25 publications

Minimally invasive anterior transarticular screw fixation and microendoscopic bone graft for atlantoaxial instability

Minimally invasive anterior transarticular screw fixation and microendoscopic bone graft for atlantoaxial instability

Atlantoaxial Subluxation Secondary to Unstable Os Odontoideum in a Patient With Arrested Hydrocephalus Due to Congenital Aqueductal Stenosis: A Case Report

Os Odontoideum: Review Article

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