Comprehensive drilling of the C1–2 facets to achieve direct posterior reduction in irreducible atlantoaxial dislocation

Salunke, Pravin; Sahoo, Sushanta K.; Deepak, Arsikere N; Ghuman, Mandeep S.; Khandelwal, Niranjan

doi:10.3171/2014.12.spine14310

Cited by 62 publications

(33 citation statements)

References 7 publications

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“…Various techniques were described in literature where all these three goals are accomplished with single surgical strategy through posterior approach. [1][2][3][4][5][6] These bony variations of CVJ are comparable with individual's fingerprints. As fingerprints of two individuals complications such as vertebral artery (VA) injury or injury to the neuraxis.…”

Section: Introductionmentioning

confidence: 64%

Knock and Drill Technique: A Simple Tips for the Instrumentation in Complex Craniovertebral Junction Anomalies without using Fluoroscopy

Srivastava

Sardhara

Behari

et al. 2017

Journal of Neurosciences in Rural Practice

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Context:Existence of complex variable bony and vertebral artery (VA) anomalies at craniovertebral junction (CVJ) in subset of complex CVJ anomalies demands individualized instrumentation policy and placing screws in each bone requires strategic preoperative planning and intraoperative skills.Aim:To evaluate the clinical accuracy of knock and drill (K and D) technique for the screw placement in complex CVJ anomalies.Settings and Design:Prospective study and operative technical note.Materials and Methods:Totally 36 consecutive patients (16 - pediatrics, 20 - adult patients) of complex CVJ: Complete/partial occipitalized C1 vertebra; at least one hypoplastic (C1/C2) articular mass, rotational component, and variations in the third part of VA were included in this study. Preoperative detail computed tomography (CT) CT CVJ with three-dimensional reconstruction was done for the assessment of CVJ anatomy and facet joint orientation. The accuracy of novel technique was assessed with postoperative CT to evaluate cortical breach in between 5th and 7th postoperative day in all the patients. All patients were underwent clinico-radiological evaluation at 6-month follow-up.Results:Totally 144 screws were placed using K and D technique (pediatric group - 64 screws, adult patients - 80 screws). Total of 12 screws were placed in C1 lateral mass in both age group without any bony cortical breach and complication. Sixteen C2 pedicle screws and 12 C2 pars screw in pediatrics and 18 C2 pedicle screws in adult patients were placed without any bony breach or VA injury. Out of thirty subaxial lateral mass screws in pediatric group, the bony breach was encountered with one screw (3.3%). Total of 38 C2 pars screws was placed in adult group in which bony breach along with VA injury was encounter with 1screw (2.6%).Conclusion:A simple technique of K and D for placing a screw increases the accuracy and spectrum of bony purchase and has the potential to reduce the complication in patients with complex CVJ anomalies.

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Section: Introductionmentioning

confidence: 64%

Knock and Drill Technique: A Simple Tips for the Instrumentation in Complex Craniovertebral Junction Anomalies without using Fluoroscopy

Srivastava

Sardhara

Behari

et al. 2017

Journal of Neurosciences in Rural Practice

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“…Such a technique has been elucidated for lateral traumatic C1-2 dislocation [2]. In the case of locked facets, drilling of the locking edge of the facets may be required to achieve reduction [7]. The vertebral artery needs to be safeguarded during drilling and manipulation [2,8].…”

Section: Discussionmentioning

confidence: 99%

Congenital C1-2 Lateral Translational Dislocation: Case Illustration with Pre- and Postoperative Imaging

Salunke

Sahoo²,

Deepak³

et al. 2016

Pediatr Neurosurg

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Background: Congenital atlantoaxial dislocation has been commonly described in the antero-posterior or vertical plane (basilar invagination). However, dislocation in the lateral translational plane due to congenital deformity is rare. Case Report: We present a case of a young male who presented with os odontoideum with C1-2 dislocation in the lateral plane along with antero-posterior dislocation. He was operated on through a midline posterior incision, and the C1-2 facet was manipulated so as to correct the dislocation in all planes. Conclusion: With os odontoideum, the C1-2 joints can exhibit movements that are out of the ordinary, even in the lateral translational plane. It suggests that the ligaments and joint capsule may weaken with time. Careful radiological evaluation helps in diagnosing this rare condition. An understanding of 3D facetal anatomy is important to achieve complete correction.

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“…The C1-2 joints were comprehensively drilled to make them flat or near normal in both sagittal and coronal planes. 20 Metallic spacers packed with bone were used to compensate for bone loss after drilling and for VD. The spacers are hollow cuboids made of titanium, measuring 16 mm in length and 9 mm in width, with a graft window of 60%.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Currently, the management for both IrAAD and RAAD focuses on opening and manipulating the C1-2 joints and fusing them through a direct posterior approach. 2,6,8,9,19,20,23 With the techniques involving joint reduction, the need to differentiate the two seems to be rapidly fading. Thus, the roles of dynamic radiography and preoperative traction are likely to be questioned.…”

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confidence: 99%

Revisiting the differences between irreducible and reducible atlantoaxial dislocation in the era of direct posterior approach and C1–2 joint manipulation

Deepak¹,

Salunke²,

Sahoo³

et al. 2017

SPI

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OBJECTIVE The current management of atlantoaxial dislocation (AAD) focuses on the C1–2 joints, commonly approached through a posterior route. The distinction between reducible AAD (RAAD) and irreducible AAD (IrAAD) seems to be less important in modern times. The roles of preoperative traction and dynamic radiographs are questionable. This study evaluated whether differentiating between the 2 groups is important in today's era. METHODS Ninety-six consecutive patients with congenital AAD (33 RAAD and 63 IrAAD), who underwent surgery through a posterior approach alone, were studied. The preoperative and follow-up clinical statuses for both groups were studied and compared using Japanese Orthopaedic Association (JOA) scores. The radiological findings of the 2 groups were compared, and the intraoperative challenges described. RESULTS A poor preoperative JOA score (clinical status) was seen in one-fifth of patients with IrAAD, although the mean JOA score was nearly similar in the RAAD and IrAAD groups. There was significant improvement in follow-up JOA score in both groups. However, segmentation defects (such as an assimilated arch of the atlas and C2–3 fusion) and anomalous vertebral arteries were found significantly more often in cases of IrAAD compared with those of RAAD. Os odontoideum was commonly seen in the RAAD group. The C1–2 joints were acute in IrAAD compared with RAAD. Preoperative traction in IrAAD resulted in vertical distraction and improvement in clinical and respiratory status. Surgery for IrAAD required much more drilling and manipulation of the C1–2 joints while safeguarding the anomalous vertebral artery. CONCLUSIONS Bony and vascular anomalies were much more common in patients with IrAAD, which made surgery more challenging than it was in RAAD despite similar approaches. An irreducible dislocation seen on preoperative radiographs made surgeons aware of difficulties that were likely to be encountered and helped them to better plan the surgery. Distraction achieved through preoperative traction reaffirmed the feasibility of intraoperative reduction. This made the differentiation between the 2 groups and the use of preoperative traction equally important.

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Comprehensive drilling of the C1–2 facets to achieve direct posterior reduction in irreducible atlantoaxial dislocation

Cited by 62 publications

References 7 publications

Knock and Drill Technique: A Simple Tips for the Instrumentation in Complex Craniovertebral Junction Anomalies without using Fluoroscopy

Knock and Drill Technique: A Simple Tips for the Instrumentation in Complex Craniovertebral Junction Anomalies without using Fluoroscopy

Congenital C1-2 Lateral Translational Dislocation: Case Illustration with Pre- and Postoperative Imaging

Revisiting the differences between irreducible and reducible atlantoaxial dislocation in the era of direct posterior approach and C1–2 joint manipulation

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