scholarly journals Basilar Invagination: Surgical Treatment by Novel Anterior Implant

2021 ◽  
Vol 11 (6) ◽  
Author(s):  
Sushil V Patkar ◽  
Pradnya Patkar
Keyword(s):  
Surgical Treatment ◽  
Basilar Invagination ◽  
Atlantoaxial Dislocation ◽  
The Body ◽  
Atlantoaxial Instability ◽  
Rigid Fixation ◽  
Titanium Plate ◽  
X Ray ◽  
Atlantoaxial Fixation ◽  
Cost Efficient

Introduction: Anterior retropharyngeal realignment, distraction, and atlantoaxial fixation are an option for the treatment of symptomatic basilar invagination (BI). The anterior implants for distraction and fixation for atlantoaxial joints are still evolving. We share our experience using a novel implant which can easily, safely, and rigidly fix both lateral masses to the body of the axis. Methods: After exposing both the atlantoaxial joints anteriorly, the joints were prepared, distracted with wedge shaped autologous tricorticate bone grafts and realigned to correct the cervicomedullary strain. The atlantoaxial joints were fixed using a novel titanium plate by passing screws upwards and laterally into the lateral masses of the atlas and centrally into the body of the axis. Post-operative imaging showed effective correction of BI and atlantoaxial dislocation. Post-operative dynamic X-ray images confirmed maintenance of rigid fixation at 6 months. Conclusion: This new plate screw construct is safe, easy, cost-efficient, and biomechanically appealing option for the treatment of symptomatic BI. Keywords: Basilar invagination, atlantoaxial dislocation, vertebral artery injury, atlantoaxial fixation, atlantoaxial instability.

scholarly journals Is atlantoaxial instability the cause of Chiari malformation? Outcome analysis of 65 patients treated by atlantoaxial fixation

2015 ◽  
Vol 22 (2) ◽  
pp. 116-127 ◽  
Author(s):  
Atul Goel
Keyword(s):  
Chiari Malformation ◽  
Basilar Invagination ◽  
Foramen Magnum ◽  
Neurological Function ◽  
Atlantoaxial Dislocation ◽  
Atlantoaxial Instability ◽  
Foramen Magnum Decompression ◽  
Atlantoaxial Fixation ◽  
Atlantoaxial Stabilization

OBJECT Understanding that atlantoaxial instability is the cause of Chiari malformation (CM), the author treated 65 patients using atlantoaxial stabilization. The results are analyzed. METHODS Cases of CM treated using atlantoaxial fixation during the period from January 2010 to November 2013 were reviewed and analyzed. Surgery was aimed at segmental arthrodesis. RESULTS The author treated 65 patients with CM in the defined study period. Fifty-five patients had associated syringomyelia. Forty-six patients had associated basilar invagination. Thirty-seven patients had both basilar invagination and syringomyelia. Three patients had been treated earlier using foramen magnum decompression and duraplasty. According to the extent of their functional capabilities, patients were divided into 5 clinical grades. On the basis of the type of facetal alignment and atlantoaxial instability, the patients were divided into 3 groups. Type I dislocation (17 patients) was anterior atlantoaxial instability wherein the facet of the atlas was dislocated anterior to the facet of the axis. Type II dislocation (31 patients) was posterior atlantoaxial instability wherein the facet of the atlas was dislocated posterior to the facet of the axis. Type III dislocation (17 patients) was the absence of demonstrable facetal malalignment and was labeled as “central” atlantoaxial dislocation. In 18 patients, dynamic images showed vertical, mobile and at-least partially reducible atlantoaxial dislocation. All patients were treated with atlantoaxial plate and screw fixation using techniques described in 1994 and 2004. Foramen magnum decompression or syrinx manipulation was not performed in any patient. Occipital bone and subaxial spinal elements were not included in the fixation construct. One patient died, and death occurred in the immediate postoperative phase and was related to a vertebral artery injury incurred during the operation. One patient had persistent symptoms. In the rest of the patients there was gratifying clinical improvement. More remarkably, in 7 patients, the symptoms of lower cranial nerve paresis improved. No patient worsened in their neurological function after surgery. Reductions in the size of the syrinx and regression of the CM were observed in 6 of 11 cases in which postoperative MRI was possible. During the follow-up period, there was no delayed worsening of neurological function or symptoms in any patient. Sixty-three patients improved after surgery, and the improvement was sustained during the average follow-up period of 18 months. CONCLUSIONS On the basis of outcomes in this study, it appears that the pathogenesis of CM with or without associated basilar invagination and/or syringomyelia is primarily related to atlantoaxial instability. The data suggest that the surgical treatment in these cases should be directed toward atlantoaxial stabilization and segmental arthrodesis. Except in cases in which there is assimilation of the atlas, inclusion of the occipital bone is neither indicated nor provides optimum stability. Foramen magnum decompression is not necessary and may be counter-effective in the long run.

Use of a titanium mesh cage for posterior atlantoaxial arthrodesis

2002 ◽  
Vol 96 (1) ◽  
pp. 127-130 ◽  
Author(s):  
Morio Matsumoto ◽  
Kazuhiro Chiba ◽  
Takashi Tsuji ◽  
Hirofumi Maruiwa ◽  
Yoshiaki Toyama ◽  
...  
Keyword(s):  
Donor Site ◽  
Atlantoaxial Instability ◽  
Os Odontoideum ◽  
Posterior Arch ◽  
Rigid Fixation ◽  
Titanium Mesh ◽  
Content Type ◽  
Atlantoaxial Fixation ◽  
Mesh Cage ◽  
Atlantoaxial Arthrodesis

✓ The authors placed titanium mesh cages to achieve posterior atlantoaxial fixation in five patients with atlantoaxial instability caused by rheumatoid arthritis or os odontoideum. A mesh cage packed with autologous cancellous bone was placed between the C-1 posterior arch and the C-2 lamina and was tightly connected with titanium wires. Combined with the use of transarticular screws, this procedure provided very rigid fixation. Solid fusion was achieved in all patients without major complications. The advantages of this method include more stable fixation, better control of the atlantoaxial fixation angle, and reduced donor-site morbidity compared with a conventional atlantoaxial arthrodesis in which an autologous iliac crest graft is used.

scholarly journals Unstable odontoid fractures: technical appraisal of anterior extrapharyangeal open reduction internal fixation for irreducible unstable odontoid fractures. Patient series

2021 ◽  
Vol 2 (20) ◽  
Author(s):  
Sushil Patkar
Keyword(s):  
Open Reduction ◽  
Facet Joint ◽  
Open Reduction Internal Fixation ◽  
Atlantoaxial Instability ◽  
Rigid Fixation ◽  
Atlantoaxial Joint ◽  
Fracture Fragment ◽  
Odontoid Fractures ◽  
Atlantoaxial Fixation ◽  
Displaced Fracture

BACKGROUND Displaced odontoid fractures that are irreducible with traction and have cervicomedullary compression by the displaced distal fracture fragment or deformity caused by facetal malalignment require early realignment and stabilization. Realignment with ultimate solid fracture fusion and atlantoaxial joint fusion, in some situations, are the aims of surgery. Fifteen such patients were treated with direct anterior extrapharyngeal open reduction and realignment of displaced fracture fragments with realignment of the atlantoaxial facets, followed by a variable screw placement (VSP) plate in compression mode across the fracture or anterior atlantoaxial fixation (transarticular screws or atlantoaxial plate screw construct) or both. OBSERVATIONS Anatomical realignment with rigid fixation was achieved in all patients. Fracture fusion without implant failure was observed in 100% of the patients at 6 months, with 1 unrelated mortality. Minimum follow-up has been 6 months in 14 patients and a maximum of 3 years in 4 patients, with 1 unrelated mortality. LESSONS Most irreducible unstable odontoid fractures can be anatomically realigned by anterior extrapharyngeal approach by facet joint manipulation. Plate (VSP) and screws permit rigid fixation in compression mode with 100% fusion. Any associated atlantoaxial instability can be treated from the same exposure.

Treatment of gynecological bleeding

1934 ◽  
Vol 30 (6) ◽  
pp. 636-636
Author(s):  
Н. Runge
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
General Condition ◽  
The Body ◽  
Foreign Protein ◽  
Second Phase ◽  
X Ray

The author recommends the following method of treatment of such bleeding: 1) at strong periods-rest, means reducing the uterus; treatment of existing diseases of organs in the interval of bleeding by infections of nonspecific means (calcium, foreign protein, own blood and serum); application of follicular hormone at hypoplasia of uterus on the basis of insufficiency of ovary; X-ray castration in women close to menopause in cases where strong monthly bleeding leads to anemia; 2) in case of frequent periods - to pay attention to the general condition of the body, in the absence of local and general changes treatment with hormones (in shortening of the second phase of the cycle - lute body hormone in the second half of the cycle, in hypoplastic uterus - follicular hormone) is indicated; 3) in bleeding on the basis of myoma- X-ray castration, if the bleeding led to anemia, the tumor is not larger than a child's head and the woman is over 45 years old; or surgical treatment; 4) in atypical bleeding-in cases of ascending endometritis, accompanied by severe inflammatory phenomena, fever a. recommends conservative treatment.

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

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaobao Zou ◽  
Bieping Ouyang ◽  
Haozhi Yang ◽  
Binbin Wang ◽  
Su Ge ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Early Stage ◽  
Plate Fixation ◽  
Japanese Orthopaedic Association ◽  
Odontoid Process ◽  
Basilar Invagination ◽  
Atlantoaxial Dislocation ◽  
Clinical Effects ◽  
Occipitocervical Fixation ◽  
Irreducible Atlantoaxial Dislocation

Abstract Background Transoral atlantoaxial reduction plate (TARP) fixation or occipitocervical fixation (OF) is an effective treatment for basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD). But, all current clinical studies involved a single surgical procedure. The clinical effects of TARP and OF operation for BI with IAAD have yet to be compared. We therefore present this report to compare the treatment of TARP and OF procedure for BI with IAAD. Methods Fifty-six patients with BI with IAAD who underwent TARP or OF operation from June 2011 to June 2017 were retrospectively analyzed. Among these, 35 patients underwent TARP operation (TARP group), and 21 patients underwent OF operation (OF group). We compared the difference of clinical, radiological, and surgical outcomes between the TARP and OF groups postoperatively. Results Compared with OF group, the operative time and blood loss in TARP group were lower. There was no statistical difference in the atlantodental interval (ADI), clivus canal angle (CCA), cervicomedullary angle (CMA), distance between the top of the odontoid process and the Chamberlain line (CL) and Japanese Orthopaedic Association (JOA) score between the TARP and OF groups preoperatively, but the improvements of these parameters in the TARP group were superior to those in the OF group postoperatively. The fusion rates were higher in the TARP group than those in the OF group at the early stage postoperatively. Conclusions TARP and OF operations are effective surgical treatment for BI with IAAD, but the performance of reduction and decompression and earlier bone fusion rates of TARP procedure are superior to those of OF.

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.

Biodegradable semirigid plate and miniscrew fixation compared with rigid titanium fixation in experimental calvarial osteotomy

1999 ◽  
Vol 90 (5) ◽  
pp. 910-917 ◽  
Author(s):  
Hilkka H. Peltoniemi ◽  
Riitta-Mari Tulamo ◽  
Terttu Toivonen ◽  
Dorrit Hallikainen ◽  
Pertti Törmälä ◽  
...  
Keyword(s):  
Magnetic Resonance Images ◽  
Frontal Bone ◽  
Rigid Fixation ◽  
Titanium Plate ◽  
Content Type ◽  
X Ray ◽  
Bone Segment ◽  
Foreign Body Reactions ◽  
Titanium Miniplate ◽  
Fine Print

Object. To determine the biocompatibility and suitability of resorbable plates and miniscrews, consolidation of symmetrical, bilateral frontal bone craniotomies that had been closed using various methods was studied in 20 growing lambs.Methods. Bone fixation with a flexible, punched polylactide plate and four slowly degradable, self-reinforced polylevolactide (SR-PLLA) or rapidly degradable, self-reinforced polyglycolide (SR-PGA) miniscrews (10 animals in each group) was compared intraindividually with rigid fixation by using a titanium miniplate and four miniscrews. Plain x-ray films, magnetic resonance images, histological studies, and histomorphometric studies were obtained at 4 to 104 weeks.Conclusions. No dislocation, instability, clinical foreign body reactions, infections, or loss of fixation were observed. Bone consolidation of the 2.35-mm-wide craniotomy lines was incomplete; connective tissue—filled defects through the bone were observed in 13 of 28 lines at 26 to 52 weeks. Statistical analyses based on histomorphometric studies showed no difference in consolidation with SR-PLLA miniscrew and titanium plate/screw fixation or between the two resorbable fixation methods. Fixation with rapidly degradable SR-PGA miniscrews resulted in less effective consolidation than on the contralateral titanium-treated side (p < 0.05), but the bone segment was thicker (p < 0.005). The SR-PGA miniscrews had disappeared by 6 weeks, the polyactide plate by 104 weeks, and the SR-PLLA miniscrews had been mostly resorbed at 104 weeks. Passive translocation of the titanium plates and screws into the bone tissue was seen at 52 and 104 weeks. In rapidly growing lamb frontal bone, comparable consolidation results, without complications, can be achieved with semirigid resorbable fixation compared with rigid metallic fixation.

scholarly journals Stage results of the use of orthoses in children after surgical treatment of congenital spine deformity (Preliminary report)

2021 ◽  
Vol 9 (1) ◽  
pp. 41-50
Author(s):  
Ignatij А. Redchenko ◽  
Sergei V. Vissarionov ◽  
Maxim G. Gusev ◽  
Grigoriy A. Lein ◽  
Ivan V. Pavlov
Keyword(s):  
Surgical Treatment ◽  
Scientific Evidence ◽  
Spinal Column ◽  
The Body ◽  
Congenital Deformity ◽  
Spine Deformity ◽  
Metal Structures ◽  
X Ray ◽  
One Year ◽  
Treatment Use

BACKGROUND: After surgical treatment of congenital spinal deformities, we can see the progression of deformities of the spinal column segments free from metal structures, which leads to the need for reoperation. Without sufficient scientific evidence, several specialists after surgical treatment use various orthoses on the body to prevent scoliotic compensatory changes. AIM: This study aims to assess the results of body orthosis after surgical treatment of children with congenital spinal deformity with the impaired formation of the vertebrae, using orthoses, compensatory deformity after one year of treatment. MATERIALS AND METHODS: Twenty-five patients aged 2 to 12 years (10 boys and 15 girls) after surgical treatment of congenital deformity of the spine in the thoracic regions (13) and lumbar regions (12), wearing body orthoses. The results were assessed at 3, 6, and 12 months using thermal sensors for the orthosis wearing time by X-ray and statistical methods. RESULTS: After three months of wearing the brace, we saw a correction of about 50% of the value of the initial compensatory deformity. After six months, both thoracic and lumbar, the correction was 60%. After one year, when performing an X-ray image without an orthosis, in thoracic deformities without a brace, the correction stabilized and remained at the level of 40%. In lumbar deformities without a brace, the original deformity returned, i.e., the correction occurred but was not fixed without the orthosis. Only one of 25 patients (4%) required a second operation to increase the fixations duration. CONCLUSION: The results of observing a group of patients (25 children) for one year after surgical treatment of congenital spine deformity showed a positive effect of a functionally corrective orthosis on the body to correct secondary deformities.

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