Reduction techniques in the management of atlantoaxial subluxation

Abstract

Background:The traditional approach to atlantoaxial subluxation which is irreducible after traction is transoral decompression and reduction or odontoid excision and posterior fixation. Transoral approach is associated with comorbidities. However using a posterior approach a combination of atlantoaxial joint space release and a variety of manipulation procedures, optimal or near optimal reduction can be achieved. We analysed our results in this study based on above procedure.Materials and Methods:66 cases treated over a 5 year period were evaluated retrospectively. Three cases treated by occipito cervical fusion were not included in the study. The remaining 63 cases were classified into three types. All except two cases were subjected to primary posterior C1-C2 joint space dissection and release followed by on table manipulation which was tailored to treat the type of atlantoaxial subluxation. Optimal or near optimal reduction was possible in all cases. An anterior transoral decompression was needed only in two cases where a bony growth (callus) between the C1 anterior arch and the odontoid precluded reduction by posterior manipulation. All cases then underwent posterior fusion and fixation procedures. Patients were neurologically and radiologically evaluated at regular followups to assess fusion and stability for a minimum period of 6 months.Results:Of the 63 cases who underwent posterior manipulation, 49 cases achieved optimum reduction and the remaining 14 cases showed near optimal reduction. Two cases expired in the postoperative period. None of the remaining cases showed neurological worsening after the procedure. Evaluation at 6 months after surgery revealed good stability and fusion in all except three cases.Conclusion:Atlantoaxial joint release and manipulation can be used to achieve reduction in most cases of atlantoaxial subluxation, obivating the need of transoral odontoid excision.

Atlantoaxial Dislocation: Surgical Outcome following Anterior Retropharyngeal Approach to Odontoid with or without Fixation

“…However, the study done by Goel et al 5 comprised of 91 males and 69 females (male to female ratio 1.3:1). In a similar study by Shetty et al, 8 out of the 63 patients there were 49 males and 14 females (male to female ratio 3.5:1).…”

Endoscopic endonasal approach to the craniovertebral junction

“…In the setting of degenerative spinal diseases such as RA, instability of this portion of the spine leads to the development of an inflammatory pannus around the odontoid, which can compress the brainstem 8 . Typically, fixation through posterior arthrodesis is curative and results in regression of the pannus 9 . When this is unsuccessful in regressing the pannus and compression persists, such as the case shown in Figure 2, the EEA can be utilized to resect the pannus allowing for decompression.…”

“… 8 Typically, fixation through posterior arthrodesis is curative and results in regression of the pannus. 9 When this is unsuccessful in regressing the pannus and compression persists, such as the case shown in Figure 2 , the EEA can be utilized to resect the pannus allowing for decompression.…”

Occipitocervical fixation using Ransford loop for neglected posttraumatic odontoid fracture with atlantoaxial dislocation: A technical note

“…The cervical magnetic resonance image showed atlantoaxial subluxation type 2©, with an increased atlantodens interval (ADI), a decreased posterior ADI, and an increased interspinous distance. [5] The spinal cord was compressed by the ring of C1 and the upper part of C2 [Figures 1 and 2].…”