Atlantoaxial Joint Distraction with a New Expandable Device for the Treatment of Basilar Invagination with Preservation of the C2 Nerve Root: A Cadaveric Anatomical Study

Object. The author discusses the successful preliminary experience of treating selected cases of basilar invagination by performing atlantoaxial joint distraction, reduction of the basilar invagination, and direct lateral mass atlantoaxial plate/screw fixation. Methods. Twenty-two patients with basilar invagination—in which the odontoid process invaginated into the foramen magnum and the tip of the odontoid process was above the Chamberlain, McRae foramen magnum, and Wackenheim clival lines—were selected to undergo surgery. In all patients fixed atlantoaxial dislocations were documented. The 16 male and six female patients ranged in age from 8 to 50 years. A history of trauma prior to the onset of symptoms was documented in 17 patients. Following surgery, the author observed minimal-to-significant reduction of basilar invagination and alteration in other craniospinal parameters resulting in restoration of alignment of the tip of the odontoid process and the clivus and the entire craniovertebral junction in all patients. In addition to neurological and radiological improvement, preoperative symptoms of torticollis resolved significantly in all patients. The minimum follow-up period was 12 months and the mean was 28 months. Conclusions. Joint distraction and firm lateral mass fixation in selected cases of basilar invagination is a reasonable surgical treatment for reducing the basilar invagination, restoring craniospinal alignment, and establishing fixation of the atlantoaxial joint.

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Craniovertebral instability due to degenerative osteoarthritis of the atlantoaxial joints: analysis of the management of 108 cases

Journal of Neurosurgery Spine ◽

10.3171/2009.12.spine0999 ◽

2010 ◽

Vol 12 (6) ◽

pp. 592-601 ◽

Cited By ~ 58

Author(s):

Atul Goel ◽

Abhidha Shah ◽

Sanjay Rajan Gupta

Keyword(s):

Cord Compression ◽

Basilar Invagination ◽

Atlantoaxial Instability ◽

Atlantoaxial Joint ◽

Lateral Mass ◽

Tissue Mass ◽

Degenerative Osteoarthritis ◽

Joint Distraction ◽

Atlantoaxial Fixation ◽

Compression Treatment

Object The authors retrospectively analyzed a series of 108 patients in whom was diagnosed atlantoaxial instability due to degenerative osteoarthritis of the atlantoaxial joints. The management issues in such cases are discussed. Methods One hundred eight patients with osteoarthritis of the atlantoaxial joints and resultant craniovertebral instability—diagnosed on the basis of presenting clinical features, radiological imaging, and direct observation of the joint status during surgery—were retrospectively analyzed. Between 1990 and 2008, these patients were treated with a C1–2 lateral mass plate and screw method of atlantoaxial fixation and joint distraction using bone graft with or without the assistance of metal spacers. Results Patient ages ranged from 48 to 84 years (average 63 years). There was a history of mild to moderate head and/or neck trauma 2 months to 11 years prior to diagnosis in 40% of the cases. All patients had symptoms of neck pain, and 82% of the patients had progressive myelopathy. A reduction in the height of the atlantoaxial lateral mass complex (100%), mobile atlantoaxial dislocation (100%), basilar invagination (68%), and periodontoid degenerative tissue mass (90%) were the more frequently encountered radiological features. Two patients died in the immediate postoperative period. At an average follow-up of 64 months, all surviving patients remarkably improved to varying degrees in their neurological condition. Conclusions Atlantoaxial joint arthritis frequently leads to craniovertebral instability and cord compression. Treatment by joint distraction and lateral mass fixation can be an optimum form of treatment.

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Delayed neurological deterioration following atlantoaxial facet joint distraction and fixation in a patient with Chiari malformation type I

Journal of Neurosurgery Spine ◽

10.3171/2017.7.spine161383 ◽

2018 ◽

Vol 28 (3) ◽

pp. 262-267 ◽

Cited By ~ 4

Author(s):

Tatsushi Inoue ◽

Natsuki Hattori ◽

Tsukasa Ganaha ◽

Tadashi Kumai ◽

Shinichiro Tateyama ◽

...

Keyword(s):

Chiari Malformation ◽

Intervention Strategy ◽

Essential Element ◽

Craniovertebral Junction ◽

Basilar Invagination ◽

Type I ◽

Atlantoaxial Joint ◽

Chiari Malformation Type I ◽

Neurological Improvement ◽

Joint Distraction

Chiari malformation type I (CM-I) is typically treated with foramen magnum decompression. However, a recent study proposed a new technique for patients with CM-I, wherein only short atlantoaxial joint fusion and distraction is applied. Posterior fusion with or without atlantoaxial distraction is a potential option for patients with CM-I associated with basilar invagination or complex anomalous bony craniovertebral junction pathology, since this procedure allows clinicians to avoid using the technically demanding transoral approach in which some or all of the odontoid tip is invisible. Distraction of the atlantoaxial joint reduces ventral cervicomedullary compression, leading to neurological improvement. Here, the authors report the case of a 50-year-old woman with CM-I plus basilar invagination whose condition immediately improved but then gradually deteriorated following atlantoaxial joint distraction and fusion. Therefore, the authors performed endonasal/transoral odontoidectomy, which resulted in prolonged neurological recovery. Short atlantoaxial fusion with distraction is a smart and ideal surgical planning concept that can result in significant neurological improvement. However, this case suggests that anterior odontoidectomy is still an essential element of the intervention strategy for patients with CM-I with complex craniovertebral junction pathology.

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Treatment of basilar invagination with atlantoaxial dislocation: atlantoaxial joint distraction and fixation with transoral atlantoaxial reduction plate (TARP) without odontoidectomy

European Spine Journal ◽

10.1007/s00586-014-3378-8 ◽

2014 ◽

Vol 23 (8) ◽

pp. 1648-1655 ◽

Cited By ~ 23

Author(s):

Hong Xia ◽

QingShui Yin ◽

FuZhi Ai ◽

XiangYang Ma ◽

JianHua Wang ◽

...

Keyword(s):

Basilar Invagination ◽

Atlantoaxial Dislocation ◽

Atlantoaxial Joint ◽

Joint Distraction

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Techniques of Atlantoaxial Fixation and the Resection of C2 Nerve Root

World Neurosurgery ◽

10.1016/j.wneu.2011.12.070 ◽

2012 ◽

Vol 78 (6) ◽

pp. 603-604 ◽

Cited By ~ 6

Author(s):

Jau-Ching Wu ◽

Tsung-Hsi Tu ◽

Praveen V. Mummaneni

Keyword(s):

Nerve Root ◽

Atlantoaxial Fixation ◽

C2 Nerve Root

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Neurovascular structures adjacent to the lumbar intervertebral discs: an anatomical study of their morphometry and relationships

Journal of Neurosurgery Spine ◽

10.3171/2010.11.spine09149 ◽

2011 ◽

Vol 14 (5) ◽

pp. 630-638 ◽

Cited By ~ 8

Author(s):

Mehmet Arslan ◽

Ayhan Cömert ◽

Halil İbrahim Açar ◽

Mevci Özdemir ◽

Alaittin Elhan ◽

...

Keyword(s):

Nerve Root ◽

Lumbar Disc ◽

Anatomical Study ◽

Intervertebral Discs ◽

Nerve Roots ◽

Disc Space ◽

Anatomical Knowledge ◽

The Mean ◽

The Right ◽

Neurovascular Structures

Object Although infrequent, injury to adjacent neurovascular structures during posterior approaches to lumbar intervertebral discs can occur. A detailed anatomical knowledge of relationships may decrease surgical complications. Methods Ten formalin-fixed male cadavers were used for this study. Posterior exposure of the lumbar thecal sac, nerve roots, pedicles, and intervertebral discs was performed. To identify retroperitoneal structures at risk during posterior lumbar discectomy, a transabdominal retroperitoneal approach was performed, and observations were made. The distances between the posterior and anterior edges of the lumbar intervertebral discs were measured, and the relationships between the disc space, pedicle, and nerve root were evaluated. Results For right and left sides, the mean distance from the inferior pedicle to the disc gradually increased from L1–2 to L4–5 (range 2.7–3.8 mm and 2.9–4.5 mm for right and left side, respectively) and slightly decreased at L5–S1. For right and left sides, the mean distance from the superior pedicle to the disc was more or less the same for all disc spaces (range 9.3–11.6 mm and 8.2–10.5 mm for right and left, respectively). The right and left mean disc-to-root distance for the L3–4 to L5–S1 levels ranged from 8.3 to 22.1 mm and 7.2 to 20.6 mm, respectively. The root origin gradually increased from L-1 to L-5. The right and left nerve root–to-disc angle gradually decreased from L-3 to S-1 (range 105°–110.6° and 99°–108°). Disc heights gradually increased from L1–2 to L5–S1 (range 11.3–17.4 mm). The mean distance between the anterior and posterior borders of the intervertebral discs ranged from 39 to 46 mm for all levels. Conclusions To avoid neighboring neurovascular structures, instrumentation should not be inserted into the lumbar disc spaces more than 3 cm from their posterior edge. Accurate anatomical knowledge of the relationships of intervertebral discs to nerve roots is needed for spine surgeons.

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

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03792-3 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Xiaobao Zou ◽

Binbin Wang ◽

Haozhi Yang ◽

Su Ge ◽

Bieping Ouyang ◽

...

Keyword(s):

Revision Surgery ◽

Odontoid Process ◽

Basilar Invagination ◽

Atlantoaxial Dislocation ◽

Atlantoaxial Instability ◽

Cervical Cord ◽

Atlantoaxial Joint ◽

Japanese Orthopedic Association ◽

Satisfactory Outcome ◽

Irreducible Atlantoaxial Dislocation

Abstract Background The revision surgery of basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD) after a previous occipitocervical fusion (OCF) is challenging. Transoral revision surgery has more advantages than a combined anterior and posterior approach in addressing this pathology. The C-JAWS is a cervical compressive staple that has been used in the lower cervical spine with many advantages. Up to now, there is no report on the application of C-JAWS in the atlantoaxial joint. We therefore present this report to investigate the clinical outcomes of transoral intraarticular cage distraction and C-JAWS fixation for revision of BI with IAAD. Methods From June 2011 to June 2015, 9 patients with BI and IAAD were revised by this technique after previous posterior OCF in our department. Plain cervical radiographs, computed tomographic scans and magnetic resonance imaging were obtained pre- and postoperatively to assess the degree of atlantoaxial dislocation and compression of the cervical cord. The Japanese Orthopedic Association (JOA) score was used to evaluate the neurological function. Results The revision surgeries were successfully performed in all patients. The average follow-up duration was 18.9 ± 7.3 months (range 9–30 months). The postoperative atlas-dens interval (ADI), cervicomedullary angle (CMA), distance between the top of the odontoid process and the Chamberlain line (CL) and JOA score were significantly improved in all patients (P < 0.05). Bony fusion was achieved after 3–9 months in all cases. No patients developed recurrent atlantoaxial instability. Conclusions Transoral revision surgery by intraarticular cage distraction and C-JAWS fixation could provide a satisfactory outcome for BI with IAAD after a previous unsuccessful posterior operation.

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