Effectiveness of posterior reduction and fixation in atlantoaxial dislocation: a retrospective cohort study of 135 patients with a treatment algorithm proposal

Reconsideration of the transoral odontoidectomy in complex craniovertebral junction patients with irreducible anterior compression

“…We previously reported a series of 135 AAD patients with a 3-year follow-up, and we proposed a treatment algorithm [13]. For both reducible and irreducible dislocation patients, direct posterior reduction and fixation procedure would first be attempted.…”

“…Treatment of AAD with BI is still challenging because of abnormal osseous anatomy, and deformities of the facet joint make the reduction of AAD difficult with cervical traction, even under general anesthesia [ 20 , 21 ]. After the introduction of the posterior distraction and fixation technique, the surgical treatment algorithm had changed from anterior transoral odontoidectomy followed by posterior instrumentation to posterior surgery only [ 1 , 4 , 13 , 20 , 22 ]. With intraoperative manipulation, spinal cord compression from the odontoid process could be alleviated by the reduction and distraction of the odontoid away from the brainstem and spinal cord.…”

“…Over the past decade, however, single-stage posterior realignment CVJ surgery to treat BI with AAD has been widely accepted as first-line treatment for this pathological entity, usually obviating the need for a transoral odontoidectomy. Good clinical and radiological outcomes have been reported in most patients with posterior-only treatment [4,[12][13][14]. However, a small proportion of patients continue to have persistent myelopathy because of incomplete decompression of the spinal cord after the index surgery.…”

“…However, a small proportion of patients continue to have persistent myelopathy because of incomplete decompression of the spinal cord after the index surgery. A second-stage transoral odontoidectomy to completely decompress the spinal cord is a salvage procedure [13]. Considering the complex bony abnormal configuration and the low overall incidence of this entity, transoral odontoidectomy is still technically demanding [8,11,15,16].…”

Retropharyngeal Reduction Plate for Treatment of Irreducible Atlantoaxial Dislocation: A Cadaveric Test and Finite Element Analysis

“…To date, available treatments for IAAD are posterior decompression, anterior release via transoral approach followed by posterior xation, and transoral atlantoaxial reduction plate (TARP) internal xation, to name a few [6][7][8]. However, traditional transoral ventral decompression or anterior release followed by posterior xation is accompanied by many inevitable disadvantages, such as a narrow and unclear surgical eld, di cult operative procedures, postoperative throat discomfort, and high-risk postoperative infection [9,10]. These disadvantages can lead to high morbidity and mortality rates.…”