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

2020 ◽  
Vol 194 ◽  
pp. 105793
Author(s):  
Yue-Qi Du ◽  
Guang-Yu Qiao ◽  
Yi-Heng Yin ◽  
Teng Li ◽  
Xin-Guang Yu
Keyword(s):  
Revision Surgery ◽  
Facet Joint ◽  
Basilar Invagination ◽  
Atlantoaxial Dislocation ◽  
Suboccipital Decompression ◽  
Joint Reduction

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.

Posterior revision surgery using an intraarticular distraction technique with cage grafting to treat atlantoaxial dislocation associated with basilar invagination

2019 ◽  
Vol 31 (4) ◽  
pp. 525-533 ◽  
Author(s):  
Wanru Duan ◽  
Dean Chou ◽  
Bowen Jiang ◽  
Zhenlei Liu ◽  
Xinghua Zhao ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Posterior Approach ◽  
Clinical Symptoms ◽  
Japanese Orthopaedic Association ◽  
Basilar Invagination ◽  
Atlantoaxial Dislocation ◽  
Posterior Surgery ◽  
Before And After ◽  
History Of

OBJECTIVEThe treatment of atlantoaxial dislocation (AAD) and basilar invagination (BI) is challenging, especially in symptomatic patients with a history of previous surgery. Although seldom reported, posterior revision surgery to revise prior constructs can be advantageous over an anterior or combined approach. The authors describe their experience in performing posterior revision surgery using Goel’s technique.METHODSThe authors reviewed patients with AAD and BI who had undergone previous posterior surgery at the cranio-cervical junction between January 2016 and September 2017. All of these patients underwent revision surgery from a posterior approach. The Japanese Orthopaedic Association (JOA) score was used to assess clinical symptoms before and after surgery. The distance from the tip of the odontoid to Chamberlain’s line, atlantodental interval (ADI), and clivus-canal angle (CCA) were used for radiographic assessment before and after surgery.RESULTSTwelve consecutive patients were reviewed. Prior surgeries were as follows: 4 patients (4/12) with posterior osseous decompression without fusion, 7 (7/12) with reduction and fusion without decompression, and 1 (1/12) with posterior osseous decompression and reduction and fusion. With the use of Goel’s technique for revision in these cases, distraction using facet spacers afforded release of the anterior soft tissue from a posterior approach. The occiput was fixated to C2 using a cantilever technique, and autologous cancellous bone was grafted into the intraarticular joints. In all 12 patients, complete reduction of BI and AAD were achieved without injury to nerves or vessels. All patients had evidence of bony fusion on CT scans within 18 months of follow-up.CONCLUSIONSPosterior revision surgery using Goel’s technique is an effective and safe revision salvage surgery for symptomatic patients with AAD and BI.

Vertical mobile and reducible atlantoaxial dislocation

2009 ◽  
Vol 11 (1) ◽  
pp. 9-14 ◽  
Author(s):  
Atul Goel ◽  
Abhidha Shah ◽  
Sanjay Rajan
Keyword(s):  
Facet Joint ◽  
Odontoid Process ◽  
Causative Factor ◽  
Basilar Invagination ◽  
Atlantoaxial Dislocation ◽  
Atlantoaxial Instability ◽  
Posterior Fixation ◽  
Neurological Improvement ◽  
Cervical Traction ◽  
King Edward Memorial Hospital

Object The authors' experience with treatment of 8 patients with “vertical mobile and reducible” atlantoaxial dislocation is reviewed. The probable pathogenesis, radiological and clinical features, and management issues in such cases are discussed. Methods Between January 2006 and March 2008, 8 patients who presented with vertical mobile and reducible atlantoaxial dislocations were treated at the Department of Neurosurgery at King Edward Memorial Hospital in Mumbai, India. The vertical atlantoaxial dislocation/basilar invagination reduced completely on extension of the neck, with no need of any cervical traction. According to the extent of superior migration of the odontoid process, and measurements based on the vertical atlantoaxial instability index, the dislocation was graded as mild, moderate, or severe. All patients were treated using the C-1 lateral mass and C-2 pars plate and screw method of fixation. Results The study group was composed of 5 male and 3 female patients (mean age 24 years, age range 8–54 years). All patients presented with the physical features of short neck, torticollis, pain in the nape of the neck, and varying degrees of quadriparesis. In 6 patients there was a history of trauma prior to the onset of major neurological symptoms. The dislocation was mild in 3 cases, moderate in 1, and severe in 4. All patients had clinical neurological improvement following surgery. The follow-up duration ranged from 4 to 30 months (mean 18 months). Conclusions Vertical mobile and reducible atlantoaxial dislocation is a discrete clinical entity. Abnormal inclination and incompetence of the facet joint appears to be the primary causative factor that resulted in vertical dislocation or basilar invagination. Posterior fixation in the reduced dislocation position forms the basis of treatment.

scholarly journals Posterior intra-articular distraction with cage placement to treat congenital atlantoaxial dislocation associated with basilar invagination

2020 ◽  
Vol 3 (1) ◽  
pp. V2
Author(s):  
Wanru Duan ◽  
Dean Chou ◽  
Fengzeng Jian ◽  
Zan Chen
Keyword(s):  
Soft Tissue ◽  
Surgical Technique ◽  
Facet Joint ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Atlantoaxial Dislocation ◽  
Link Type

Congenital atlantoaxial dislocation (AAD) associated with basilar invagination (BI) is a complex congenital malalignment at the craniovertebral junction. The olisthesis, atlantoaxial facet joint arthropathy, and the contraction of the anterior soft tissue make the treatment challenging. Our video demonstrates the surgical technique for posterior intra-articular distraction with cage placement to treat congenital atlantoaxial dislocation associated with basilar invagination.The video can be found here: https://youtu.be/7EQqW96HhN8

Posterior Reduction of Fixed Atlantoaxial Dislocation and Basilar Invagination by Atlantoaxial Facet Joint Release and Fixation: A Modified Technique With 174 Cases

Neurosurgery ◽  
2015 ◽  
Vol 78 (3) ◽  
pp. 391-400 ◽  
Author(s):  
Yi-heng Yin ◽  
Huai-yu Tong ◽  
Guang-yu Qiao ◽  
Xin-guang Yu
Keyword(s):  
Facet Joint ◽  
Basilar Invagination ◽  
Atlantoaxial Dislocation ◽  
Modified Technique ◽  
Japanese Orthopedic Association ◽  
Neurological Improvement ◽  
Transoral Odontoidectomy ◽  
Cervical Traction ◽  
Transoral Decompression

Abstract BACKGROUND: Treatment of fixed atlantoaxial dislocation (AAD) with basilar invagination (BI) is challenging. OBJECTIVE: To introduce a modified technique to reduce fixed AAD and BI through a posterior approach. METHODS: From 2007 to 2013, 174 patients with fixed AAD and BI underwent surgical reduction by posterior atlantoaxial facet joint release and fixation technique. RESULTS: There was 1 death in the series, and 3 patients were lost to follow-up. The follow-up period ranged from 12 to 52 months (mean: 35.2 months) for the remaining 170 patients. Neurological improvement was observed in 168 of 170 patients (98.8%), and was stable in 1 (0.06%) and exacerbated in 1 (0.06%), with the Japanese Orthopedic Association scores increasing from 11.4 preoperatively to 15.8 postoperatively (P &lt; .01). Radiologically, complete or &gt;90% reduction was attained in 107 patients (62.9%), 60% to 90% reduction was attained in 51 patients (30%), and &lt;50% reduction was attained in 12 patients (7.1%), who underwent additional transoral decompression. Complete decompression was demonstrated in all 170 patients. Solid bony fusion was demonstrated in 167 patients at follow-up (98.2%). CONCLUSION: This series showed the safety and efficacy of the posterior C1-2 facet joint release and reduction technique for the treatment of AAD and BI. Most fixed AAD and BI cases are reducible via this method. In most cases, this method avoids transoral odontoidectomy and cervical traction. Compared with the occiput-C2 screw method, this short-segment C1-2 technique exerts less antireduction shearing force, guarantees longer bone purchase, and provides more immediate stabilization.

Immediate postoperative regression of retroodontoid pannus after lateral mass reconstruction in a patient with rheumatoid disease of the craniovertebral junction

2008 ◽  
Vol 9 (3) ◽  
pp. 273-276 ◽  
Author(s):  
Atul Goel ◽  
Nitin Dange
Keyword(s):  
Bone Graft ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Atlantoaxial Dislocation ◽  
Postoperative Phase ◽  
Complete Disappearance ◽  
Lateral Mass ◽  
Rheumatoid Disease ◽  
Mass Reconstruction

The authors report the case of a 35-year-old man who had polyarthritic affliction with rheumatoid disease. He presented with complaints of quadriparesis that had progressed over the course of 2 years. Investigations revealed telltale evidence of rheumatoid disease of the craniovertebral junction with retroodontoid pannus, basilar invagination, and “fixed” atlantoaxial dislocation. The patient underwent lateral mass reconstruction with distraction of the facets and impaction of a spiked metal spacer and bone graft within the joint. Investigations done in the immediate postoperative phase showed complete disappearance of retroodontoid pannus in addition to reduction of basilar invagination and atlantoaxial dislocation. He had remarkable and sustained relief from symptoms. The authors also review the pathogenesis and treatment of retroodontoid pannus.

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