The single transoral approach for Os odontoideum with irreducible atlantoaxial dislocation

Abstract

We report a 52-year-old female patient with a 2-year history of local neck pain, decreased cervical spine rotation, progressive numbness and weakness of both arms. Preoperative, dynamic X-rays, computed tomography, three-dimensional computed tomography demonstrated a displaced Os odontoideum with irreducible Subluxation of C1/2. We used a single transoral approach release, reduction using an assistance of skull traction, bone fusion and stabilization in the treatment of Os odontoideum with irreducible alantoaxial dislocation. Postoperative, the patient was free of all symptoms and X-rays taken showed a stable fusion of C1/2 at 6th postoperative month. This technique in the treatment of Os odontoideum with irreducible alantoaxial dislocation is atraumatic and effective. And preoperative dynamic X-rays, computed tomography, three-dimensional computed tomography and MRI scans provided an invaluable aid to select this operative procedure.

Bipartite Atlas With Os Odontoideum and Synovial Cyst

“…Results reported were satisfactory. [12][13][14][15][16][17][18]28,29 In patient with atlantoaxial instability, C1-C2 fusion is necessary. Spontaneous regressions of cysts were observed after stabilizing the C1-C2 joint.…”

Transoral Approach for Revision Surgery of Os Odontoideum With Atlantoaxial Dislocation

“…Otherwise, they recommended decompressive surgery through a transoral approach, with subsequent fixation. In addition, Wang et al, 15 in a report of a 52-year-old woman with os odontoideum and irreducible atlantoaxial dislocation who underwent surgery with a transoral approach for release, reduction, fusion, and stabilization, concluded that the transoral approach was an atraumatic and effective operative procedure.…”

Endoscopic Transoral Excision of Odontoid Process in Irreducible Atlantoaxial Dislocation: Our Experience of 34 Patients

“…The surgical approaches available for irreducible AAD with or without basilar invasion are the transoral microscopic resection, endoscopic transnasal excision, and endoscopic transoral excision. There are also reports of transcervical excision of the odontoid process, [26][27][28] anterior release and anterior fusion, 2,22,23,29,30 anterior release and posterior fusion, 27,28 and posterior approach with reduction and fusion. 31,32 Endoscopic transoral excision of the odontoid process was found to be direct, effective, and safe in our study.…”

“…It also has its own limitations, especially difficulties in excision of the lower body of C2. 9,33 The transoral microscopic technique 5 and endonasal, 34 endoscopic, transoral, 34 and transcervical approaches [26][27][28][29][30][31][32][33][34] for odontoid exposure have their own limitations. Combined transoral and transnasal approaches could be used for decompression of lesions located high above the level of the palate and extending below the lower part of C2.…”