Anterior Retropharyngeal Reduction and Sequential Posterior Fusion for Atlantoaxial Rotatory Fixation With Locked C1–C2 Lateral Facet

Chen, Qi; Yang, Xi; Zhou, Chunguang; Liu, Limin; Song, Yueming

doi:10.1097/brs.0000000000001018

Cited by 10 publications

(6 citation statements)

References 31 publications

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“…In 31 out of 56 cases, AARF was depicted and treated early on, 3,5,6,[8][9][10][11][12][13][14][15]17,18,[23][24][25][26][27][28][29][30][31][32][33][34][35]37 where in 25 instances, the diagnosis was made with significant delay. [4][5][6]11,16,[18][19][20][21][22]24,36 Hopefully, our review shows that only 25 out of 31 cases of the early diagnosed adults responded to traction and manipulation, whereas only 6 cases remained refractory to conservative measures. 3,5,11,22,28 Four out of these 6 cases were left untreated, but in the first 4 decades of 20th century, and the remaining 2 underwent a surgical open reduction.…”

Section: Discussionmentioning

confidence: 99%

“…Another probable scenario is when an open reduction is required in the adult refractory to close reduction, as it was observed in 19 adult cases with delayed diagnosed. 10, 16,19,21,23,28,36 Persistence of the displacement in a traumatic AARF with a failure of reduction is almost certainly due to damage of the joint capsule or the synovial enfolding and an interposition and invagination of the soft tissues into the joint that is further aggravated by muscle spasms and ligamentous contractures.…”

Section: Irreducible Chronic Aarfmentioning

confidence: 99%

“…High anterior cervical, transoral, retropharyngeal, and extreme lateral approach were the routes that have been addressed specifically for this purpose. 10,16,19,21,23,28,36,[41][42][43][44][45][46][47][48][49][50][51][52][53][54] After disengagement was achieved, some surgeons prefer to put the patient in external immobilization by using a halo vest, in particular in children. Their rationale had been to preserve neck rotation after removal of halo vest.…”

Section: Irreducible Chronic Aarfmentioning

confidence: 99%

“…1,2,6-8,15,17,18,24-27,29-32;37,39-44 However, with a considerable delay in diagnosis, and from the diagnosis time to the initiation of treatment, the condition might remain refractory to conservative measures, particularly in adults. [3][4][5]10,16,[19][20][21][22][23]28,36 In such instances, release of the corresponding facet joints and their reduction with subsequent external or internal fixation will be justified. [3][4][5]10,16,[19][20][21][22][23]28,36,[40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] The surgical intervention for achievement of these issues can be done via anterior, extreme lateral and posterior approaches.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5]10,16,[19][20][21][22][23]28,36 In such instances, release of the corresponding facet joints and their reduction with subsequent external or internal fixation will be justified. [3][4][5]10,16,[19][20][21][22][23]28,36,[40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] The surgical intervention for achievement of these issues can be done via anterior, extreme lateral and posterior approaches. 10,19,21,28,36, Among these corridors, the posterior approach is more advantageous, since all steps of surgery could have been done in 1 stage with fewer approachrelated complications.…”

Section: Introductionmentioning

confidence: 99%

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Traumatic Chronic Irreducible Atlantoaxial Rotatory Fixation in Adults: Review of the Literature, With Two New Examples

2019

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Atlantoaxial rotatory fixation (AARF) is a rare condition in adults and is almost always due to an accompanying trauma. The first example of traumatic AARF in adults was reported by Corner in 1907 and since then only 55 adult cases with this rare traumatic scenario have been published so far. Approximately 80% of adults with traumatic AARF are diagnosed soon after the traumatic events. However, in the remaining casualties, the condition might be missed with some delay from the diagnosis to treatment. If this pathology is diagnosed early enough, the conservative attempts for a closed reduction are usually effective. After closed reduction, external immobilization is required to prevent recurrence of the dislocation. However, with delayed diagnosis, the condition may remain refractory to traction on manipulation and require an open reduction instead. In the literature, such irreducible chronic AARFs are rarely reported, being confined to only 14 adult examples, in whom surgical intervention for correction of the deformity will be required. In such cases, release of the atlantoaxial facet joints is the first surgical step. In the subsequent step, reduction of the dislocated facet joints can be done via one of the already described maneuvers. As the final step, C1-C2 fixation will be necessary for prevention of re-dislocation. Herein, 2 adult patients with chronic rotatory atlantoaxial dislocation of traumatic origin are presented. In both cases, cranial traction and manipulations were ineffective and therefore an open reduction procedure was proposed and accomplished via the posterior midline corridor. The transverse rod technique was implemented subsequent to the atlantoaxial facet release. After correction of the deformity, a C1-C2 fixation was accomplished followed by arthrodesis. In addition to the outlined procedure, an historical review of the literature on this subject from the beginning of 20th century is demonstrated.

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