Anterior retropharyngeal cage distraction with atlantoaxial plate-screw fixation for basilar invagination with atlantoaxial dislocation

Patkar, Sushil

doi:10.3171/2020.4.focusvid.20157

Cited by 2 publications

(2 citation statements)

References 5 publications

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“…In appropriately selected cases (angle of the mandible is at or above the C2-3 disc in lateral X-ray in extension), the atlantoaxial joints can easily and safely be approached anteriorly in supine position by a unilateral submandibular retropharyngeal approach as described earlier [ 18 , 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Basilar Invagination: Surgical Treatment by Novel Anterior Implant

Patkar¹,

Patkar²

2021

JOCR

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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.

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Section: Discussionmentioning

confidence: 99%

Basilar Invagination: Surgical Treatment by Novel Anterior Implant

Patkar¹,

Patkar²

2021

JOCR

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“…19 The anterior approach for atlantoaxial stabilization has been described in literature. [20][21][22][23] The anterior extrapharyngeal VSP plate screw fixation for odontoid fractures can be performed in most cases (more than 95%) when, on extension, the angles of the mandible are at or above the C2-3 disc space on a lateral radiograph. 24,25 The unilateral anterior extrapharyngeal approach to both the atlantoaxial joints is without any risk to the vertebral arteries and preserves the C2 root.…”

Section: Observationsmentioning

confidence: 99%

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

Patkar¹

2021

Journal of Neurosurgery: Case Lessons

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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.

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Anterior retropharyngeal cage distraction with atlantoaxial plate-screw fixation for basilar invagination with atlantoaxial dislocation

Cited by 2 publications

References 5 publications

Basilar Invagination: Surgical Treatment by Novel Anterior Implant

Basilar Invagination: Surgical Treatment by Novel Anterior Implant

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

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