Posterior atlantoaxial facet joint reduction, fixation and fusion as revision surgery for failed suboccipital decompression in patients with basilar invagination and atlantoaxial dislocation: Operative nuances, challenges and outcomes

Du, Yue-Qi; Qiao, Guangyu; Yin, Yong; Li, Teng; Yu, Xinguang

doi:10.1016/j.clineuro.2020.105793

Cited by 10 publications

(9 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Occipital/neck pain was reported in seven articles: 192 of 328 patients (58.5%) had symptoms of occipital/neck pain. 4 , 5 , 7 , 12 , 15 , 19 , 20 In the six articles that reported paresthesias, 221 of 307 patients (72.0%) were affected. 4 , 5 , 7 , 12 , 15 , 19 Five articles reported weakness.…”

Section: Resultsmentioning

confidence: 99%

“…Clinical improvement was assessed in six (50.0%) of the articles, and Japanese Orthopedic Association (JOA) scores were outcomes in three (25.0%) studies. 4 , 5 , 14 , 15 , 19 , 20 , 21 , 22 Syrinx regression or collapse, delayed fusion, Nurick grades, and Visual Analogue Scale (VAS) neck pain scores were outcomes measured in one (8.3%) study each. 4 , 12 , 16 , 23 ( Table 3 ).…”

Section: Resultsmentioning

confidence: 99%

“…Posterior atlantoaxial facet joint reduction, fixation, and fusion was successful in improving JOA scores in a cohort of patients with CM-1, BI, and AAD who had previously undergone simple PFD. 20 These patients presented for revision surgery with occiput/neck pain, extremities weakness, paresthesia, and ataxia. 20 …”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Treatment of Chiari malformations with craniovertebral junction anomalies: Where do we stand today?

Vazquez

Dominguez

Das

et al. 2023

World Neurosurgery: X

View full text Add to dashboard Cite

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Treatment of Chiari malformations with craniovertebral junction anomalies: Where do we stand today?

Vazquez

Dominguez

Das

et al. 2023

World Neurosurgery: X

View full text Add to dashboard Cite

“…Besides, the patients with atlantoaxial dislocation accompanied with basilar invagination tended to have a high rate of vertebral artery variation, which may have a higher risk of vertebral artery injury in the operation. Therefore, occipital condylar screws might have more difficulty and risk in revision operation, and there has tended to be an alternative of occipital plate 27 , 28 , especially for the cases who were not suitable for the placement of occipital plates due to occipital defects caused by tumors, congenital dysplasia, or iatrogenic factors. In summary, the occipital plate‐screw system was still preferred for occipitocervical revision surgery, while preoperative CT scan could not be ignored to evaluate the thickness of the occipital 12 .…”

Section: Discussionmentioning

confidence: 99%

Occipitocervical Revision Surgery Using the Bicortical Screw and Plate System for Failed Craniovertebral Junction Stabilization

Sun

Yang

et al. 2021

Orthopaedic Surgery

View full text Add to dashboard Cite

Background: To evaluate the clinical efficacy and safety of the modified technique utilizing the occipital bicortical screws and plate system in occipitocervical revision surgery.Methods: Between October 2010 and May 2018, 12 consecutive patients were retrospectively evaluated. All patients had posterior occipitocervical resurgery utilizing modified technique of bicortical screws and occipital plate. The measurements of extracranial occiput on midline were conducted on computed tomography (CT) scans. The thickness of the occipital bone at the location of external occipital protuberance and below 15 mm were evaluated, respectively. For the procedure, the trajectory was drilled perpendicular to the external occipital protuberance for the specified depth with a depth-limited drilling, 2 mm away from the internal bone plate, then the trajectory was deepened at intervals of 1 mm each time until reaching the internal bone plate. Meanwhile, a probe was used to explore all the walls of the trajectory. Bicortical screws were inserted to the occipital plate and the depth of penetration was less than 2 mm from the internal bone plate. Clinical efficacy and radiographic evaluation were followed up. Results:The thickest point was the external occipital protuberance, which was 15.49 AE 1.47 mm and decreased gradually on the midline to 13.41 AE 1.60 mm at below 15 mm. Twelve cases (mean age 41.17 years; range, 24-62 years), including five males and seven females, were followed up for 24.08 months (14-32 months). The interval time was 40.42 months (3-156 months) after the initial operation. At the final follow-up, JOA score increased from 8.58 AE 2.53 before surgery to 12.67 AE 1.84 (P < 0.05) and VAS score improved from 6.17 AE 1.21 to 2.08 AE 1.32 (P < 0.05). Besides, clinical symptoms were relieved in all patients after revision surgery. All patients had rigid internal fixations with bone fusion and no major complications occurred. Conclusions:Posterior occipitocervical plate-screw system with bicortical screws had the advantages of safety, simple and promising efficacy without excessive tissue release or intraspinal manipulation, proving that it's valuable as a modified technique for occipitocervical revision surgery.

show abstract

“…However, there are still some patients whose cases prove refractory to reduction attempts from the posterior approach. In the recent treatment algorithm of atlantoaxial dislocation, 15,16 patients will first undergo posterior release followed by anterior odontoidectomy. 15 The 2-stage surgery and the complications of odontoidectomy 17 can create a substantial physical burden for the patients.…”

mentioning

confidence: 99%

A Novel Stepwise Technique for Safe and Effective Transoral Release of Irreducible Atlantoaxial Dislocation

et al. 2023

Spine

View full text Add to dashboard Cite

Study Design. Retrospective cohort study. Objective. To verify the clinical efficacy of a novel transoral stepwise release technique (TSRT) for the treatment of irreducible atlantoaxial dislocations (IAAD). Summary of Background Data. Anterior release for IAAD remains challenging, with a 3.2 times higher complication rate than posterior release. However, there are some patients who cannot achieve successful reduction from a posterior approach and require the higher-risk anterior release. Our work presents a novel anterior release technique that aims to minimize iatrogenic injury and associated complications from an anterior release. Materials and Methods. IAAD cases who were treated with TSRT were retrospectively studied. Primary outcomes included fusion rate, complications, and neurological function over the course of a minimum 1-year follow-up. Radiographic differences between preoperative and postoperative imaging were also considered. A preoperative prediction model for the actual release grade was developed using multivariate logistic regression based on demographic factors and the craniovertebral abnormalities identified on preoperative images, evaluating the need for higher-grade TSRT release. Results. We included 201 IAAD cases, with 42% (84/201) demonstrating degeneration of the atlantoaxial joint or anterior–hook-like dens. The reduction was achieved in all cases, with 80% (160/201) of cases only requiring relatively low-grade or grade I types TSRT release. Degeneration of the atlantoaxial joint was significantly associated with the need for higher-grade TSRT release (odds ratio:16.68, CI: 2.91–94.54, P = 0.002). The overall complication rate was 4.5% (9/201). Over the course of follow-up, the fusion rate reached 98.5%, and the American Spinal Injury Association and Japanese Orthopedic Association scores were significantly improved to 97.28 and 16.25 (P < 0.01 and P < 0.01), respectively. Conclusion. This study demonstrated that our novel TSRT anterior release technique demonstrated complication rates similar to those published in the literature for posterior release. TSRT can be used as an alternative to posterior release techniques for refractory cases or when a posterior approach is not considered viable.

show abstract

Posterior atlantoaxial facet joint reduction, fixation and fusion as revision surgery for failed suboccipital decompression in patients with basilar invagination and atlantoaxial dislocation: Operative nuances, challenges and outcomes

Cited by 10 publications

References 28 publications

Treatment of Chiari malformations with craniovertebral junction anomalies: Where do we stand today?

Treatment of Chiari malformations with craniovertebral junction anomalies: Where do we stand today?

Occipitocervical Revision Surgery Using the Bicortical Screw and Plate System for Failed Craniovertebral Junction Stabilization

A Novel Stepwise Technique for Safe and Effective Transoral Release of Irreducible Atlantoaxial Dislocation

Contact Info

Product

Resources

About