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

2014 ◽  
Vol 23 (8) ◽  
pp. 1648-1655 ◽  
Author(s):  
Hong Xia ◽  
QingShui Yin ◽  
FuZhi Ai ◽  
XiangYang Ma ◽  
JianHua Wang ◽  
...  
Keyword(s):  
Basilar Invagination ◽  
Atlantoaxial Dislocation ◽  
Atlantoaxial Joint ◽  
Joint Distraction

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

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.

Atlantoaxial Joint Distraction for the Treatment of Basilar Invagination: Clinical Outcomes and Radiographic Evaluation

2018 ◽  
Vol 111 ◽  
pp. e135-e141 ◽  
Author(s):  
Sibin Lan ◽  
Junjie Xu ◽  
Zenghui Wu ◽  
Hong Xia ◽  
Xiangyang Ma ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Basilar Invagination ◽  
Radiographic Evaluation ◽  
Atlantoaxial Joint ◽  
Joint Distraction

Treatment of basilar invagination by atlantoaxial joint distraction and direct lateral mass fixation

2004 ◽  
Vol 1 (3) ◽  
pp. 281-286 ◽  
Author(s):  
Atul Goel
Keyword(s):  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Foramen Magnum ◽  
Atlantoaxial Joint ◽  
Lateral Mass ◽  
Content Type ◽  
Joint Distraction ◽  
History Of ◽  
Fine Print

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.

The Severity of Basilar Invagination and Atlantoaxial Dislocation Correlates With Sagittal Joint Inclination, Coronal Joint Inclination, and Craniocervical Tilt: A Description of New Indexes for the Craniovertebral Junction

2014 ◽  
Vol 10 (4) ◽  
pp. 621-630 ◽  
Author(s):  
P. Sarat Chandra ◽  
Nishant Goyal ◽  
Avnish Chauhan ◽  
Abuzer Ansari ◽  
Bhawani Shankar Sharma ◽  
...  
Keyword(s):  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Current Data ◽  
Atlantoaxial Dislocation ◽  
Joint Orientation ◽  
Control Subjects ◽  
Standard Procedures ◽  
Joint Distraction ◽  
The Mean ◽  
Joint Inclination

Abstract BACKGROUND: Joint-distraction and intra-operative manipulation surgeries to correct basilar invagination (BI) and atlantoaxial dislocation (AAD) are becoming standard procedures. However, current data are unable to aid in the understanding of normal and abnormal morphology of the C1/C2 joints. OBJECTIVE: To study various aspects of C1/C2 joint morphology to create normative and patient data on joint abnormalities that could provide the surgeon with objective data for surgical planning and approach. METHODS: Seventy patients (age, 15-45 years) were compared with an equal number of age- and sex-matched control subjects (age, 21.9 ± 8.2 years) with irreducible BI and AAD from a developmental origin (May 2010-July 2013). Joint anatomy was studied with the use of thin-slice computed tomography scans. The joint parameters studied included sagittal joint inclination, craniocervical tilt, coronal joint inclination, surface area, joint overlap index, and joint reciprocity. The severity of BI and the severity of AAD were compared. RESULTS: Sagittal joint inclination and craniocervical tilt significantly correlated with both BI and AAD (P &lt; .01). Coronal joint inclination correlated with BI (P = .2). The mean sagittal joint inclination value in control subjects was 87.15 ± 5.65° and in patients with BI and AAD was 127.1 ± 22.05°. The mean craniocervical tilt value in controls was 60.2 ± 9.2° and in patients with BI and AAD was 84.0 ± 15.1°. The mean coronal joint inclination value in control subjects was 110.3 ± 4.23° and in patients with BI and AAD was 121.15 ± 14.6°. CONCLUSION: This study has demonstrated for the first time the important role of joint orientation and its correlation with the severity of BI and AAD and has described new joint indexes.

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

2010 ◽  
Vol 12 (6) ◽  
pp. 592-601 ◽  
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.

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

2018 ◽  
Vol 28 (3) ◽  
pp. 262-267 ◽  
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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