Transoral Approach for Revision Surgery of Os Odontoideum With Atlantoaxial Dislocation

Abstract

Revision surgery for os odontoideum with irreducible atlantoaxial dislocation with a transoral approach is not commonly seen. Typically, management of this type of atlantoaxial dislocation is through posterior fixation and fusion or transoral decompression and posterior fusion. This report describes revision surgery in a patient with os odontoideum who was treated with a transoral approach. A 50-year-old man was diagnosed with os odontoideum and atlantoaxial dislocation in 2007 and was treated surgically with posterior occipitocervical internal fixation and fusion. In 2012, he had recurrence of neck pain and numbness of the limbs. Neurologic function was grade D according to the standard neurologic classification of spinal cord injury from the American Spinal Injury Association. Because this was a revision surgery, the internal fixation implant was removed through a posterior approach and a transoral approach was used for release, reduction, internal fixation, and fusion. Two 6-mm cages filled with autogenous bone were introduced into the lateral mass spaces for bony fusion and distraction, and 2 cervical compressive mini-frames were used for fixation. Complete atlantoaxial reduction and decompression of the spinal cord were achieved. The patient reported improvement of symptoms after surgery. Movement of the extremities increased from grade III force to grade V, and neurologic status improved from American Spinal Injury Association grade D to grade E. A transoral approach for release, reduction, bony fusion, and fixation could be an effective procedure for the treatment of os odontoideum with irreducible atlantoaxial dislocation. It provides a new option for bony fusion and internal fixation of the atlantoaxial joint.

Surgical treatment for basilar invagination with irreducible atlantoaxial dislocation: transoral atlantoaxial reduction plate fixation vs occipitocervical fixation

“…Most surgeons select OF fixation mainly because of this complication. TARP fixation might be more possible to cause the occurrence and spread of infection [24][25][26]. But, with proper preoperative preparation and postoperative care, the complication rate can be reduced.…”

Transoral intraarticular cage distraction and C-JAWS fixation for revision of basilar invagination with irreducible atlantoaxial dislocation

“…Yang et al [ 5 ] presented 30 cases with BI and IAAD after posterior fossa decompression with or without fixation, and satisfactory decompressions and improvement of neurological functions with only loss of craniocervical junction mobility were obtained through transoral anterior revision surgeries using TARP system. Wu et al [ 23 ] reported 1 patient of os odontoideum with IAAD treated by a previous failed posterior operation undergoing a successful transoral revision surgery using TARP system. But, according to our clinical experience, to conveniently accomplish the surgical procedures in a limited oral space, especially for patients with a small mouth is difficult for the high thickness and large shape of the TARP.…”

Os odontoideum

“…The most common surgical approach is posterior C1-C2 fixation and fusion using screw instrumentation. [ 16 , 89 , 96 ] Transarticular C1-C2 screw fixation (TASF) is one such technique used to achieve biomechanical stability with high fusion rates and low-profile instrumentation. [ 10 , 80 , 97 ] However, TASF is limited to patients with reduced atlantoaxial joints and places the vertebral artery at risk due to its technical difficulty.…”

“…Although fusion rates are typically high with the advent of contemporary screw-based techniques, some OO patients undergo revision surgery. [ 10 , 26 , 96 , 110 ] Anterior lesions such as synovial cysts may regress following successful posterior stabilization. [ 111 , 112 ] Postoperative development of subaxial subluxation and degenerative disk diseases like kyphosis have also been reported after C1-C2 fixation and fusion.…”