Transoral Decompression of Atlanto-Axial Dislocation Due to Odontoid Hypoplasia

Greenberg, Alvin D.; Scoville, William Beecher; Davey, Lycurgus M.

doi:10.3171/jns.1968.28.3.0266

Cited by 90 publications

(35 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Surgical Technique Transoral surgery was performed as described previously, with some modifications [9,10]. A nasogastric feeding tube was placed and parenteral antibiotics were given prophylactically.…”

Section: Methodsmentioning

confidence: 99%

Unstable atlas fracture treatment by anterior plate C1-ring osteosynthesis using a transoral approach

et al. 2013

Eur Spine J

View full text Add to dashboard Cite

Study design A retrospective study was conducted to evaluate anterior plate fixation of unstable atlas fractures using a transoral approach. Objective To further investigate the safety and efficacy of this surgical technique, as there is currently a paucity of available data. Summary of background data While most atlas fractures can be managed by external immobilization with favorable results, surgery is usually preferable in highly unstable cases. Surgical stabilization is most commonly achieved using a posterior approach with fixation of C1-C2 or C0-C2, but these techniques usually result in loss of joint function and cannot fully stabilize anterior arch fractures of the atlas. Although a transoral approach circumvents these issues, only nine cases were described in the literature to our knowledge. Methods Twenty patients with unstable atlas fractures were treated with this technique during a 6-year period. Screw and plate placement, bone fusion, and integrity of spinal cord and vertebral arteries were assessed via intraoperative and follow-up imaging. Neurologic function, range of motion, strength, pain levels, and signs of infection were assessed clinically upon follow-up.Results There were no incidents of screw loosening or breakage, plate displacement, spinal cord injury, or vertebral artery injury. A total of 20 plates were placed and all 40 screws were inserted into the atlas lateral masses. CT scans demonstrated that two screws were placed too close to the vertebral artery canal, but without clinical consequences. Imaging demonstrated that bone fusion was achieved in all cases by 6 months postoperatively, without intervertebral instability. No plate-related complications were observed in any patients during the follow-up period. Conclusions C1 anterior plate fixation using a transoral approach appears to be a safe, reliable, and function-preserving surgical method for the management of unstable atlas fractures. For this type of fracture, a transoral approach with anterior fixation should be considered as an alternative to posterior approaches or conservative treatments.

show abstract

Section: Methodsmentioning

confidence: 99%

Unstable atlas fracture treatment by anterior plate C1-ring osteosynthesis using a transoral approach

et al. 2013

Eur Spine J

View full text Add to dashboard Cite

show abstract

“…However, in their discussion of the approach, Fang and Ong thought that infection could be reduced with meticulous closure of the posterior pharyngeal wall, proper preoperative oral preparation, and preoperative and postoperative antibiotics. 23 Despite this discussion and understanding, the approach was only used sporadically in case reports in the 1960s 7,32 and early 1970s. 6, 94 In these reports, refinement of the procedure and the development and widespread availability of the operating microscope helped limit complications, and the approach proved effective for lesions at the ventral CVJ.…”

Section: 77 Transoral Approaches To the Cvj-historical Beginningsmentioning

confidence: 99%

Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update

Dlouhy

Dahdaleh

Menezes³

et al. 2015

FOC

View full text Add to dashboard Cite

The craniovertebral junction (CVJ), or the craniocervical junction (CCJ) as it is otherwise known, houses the crossroads of the CNS and is composed of the occipital bone that surrounds the foramen magnum, the atlas vertebrae, the axis vertebrae, and their associated ligaments and musculature. The musculoskeletal organization of the CVJ is unique and complex, resulting in a wide range of congenital, developmental, and acquired pathology. The refinements of the transoral approach to the CVJ by the senior author (A.H.M.) in the late 1970s revolutionized the treatment of CVJ pathology. At the same time, a physiological approach to CVJ management was adopted at the University of Iowa Hospitals and Clinics in 1977 based on the stability and motion dynamics of the CVJ and the site of encroachment, incorporating the transoral approach for irreducible ventral CVJ pathology. Since then, approaches and techniques to treat ventral CVJ lesions have evolved. In the last 40 years at University of Iowa Hospitals and Clinics, multiple approaches to the CVJ have evolved and a better understanding of CVJ pathology has been established. In addition, new reduction strategies that have diminished the need to perform ventral decompressive approaches have been developed and implemented. In this era of surgical subspecialization, to properly treat complex CVJ pathology, the CVJ specialist must be trained in skull base transoral and endoscopic endonasal approaches, pediatric and adult CVJ spine surgery, and must understand and be able to treat the complex CSF dynamics present in CVJ pathology to provide the appropriate, optimal, and tailored treatment strategy for each individual patient, both child and adult. This is a comprehensive review of the history and evolution of the transoral approaches, extended transoral approaches, endoscopie assisted transoral approaches, endoscopie endonasal approaches, and CVJ reduction strategies. Incorporating these advancements, the authors update the initial algorithm for the treatment of CVJ abnormalities first published in 1980 by the senior author.

show abstract

“…Transoral odontoid resection is an effective and safe surgical procedure. Several authors have described good results obtained with this procedure [7,8,16,17,30,39,44,45,[60][61][62], but very few studies have been published about the transoral approach including odontoid resection for irreducible AAK [22,24,35,53,59].…”

Section: Discussionmentioning

confidence: 99%

Stage-related surgery for cervical spine instability in rheumatoid arthritis

Kandziora

Mittlmeier

Kerschbaumer

1999

European Spine Journal

View full text Add to dashboard Cite

Thirty-six consecutive patients with cervical spine instability due to rheumatoid arthritis (RA) were treated surgically according to a stage-related therapeutic concept. The aim of this study was to investigate the clinical results of these procedures. The initial change in RA of the cervical spine is atlanto-axial instability (AAI) due to incompetence of the cranio-cervical junction ligaments, followed by development of a peridontoid mass of granulation tissue. This results in inflammatory involvement of, and excessive dynamic forces on, the lateral masses of C1 and C2, leading to irreducible atlanto-axial kyphosis (AAK). Finally, cranial settling (CS) accompanied by subaxial subluxation (SAS) occurs. According to these three separate pathological and radiological lesions, the patients were divided into three therapeutic groups. Group I comprised 14 patients with isolated anterior AAI, who were treated by posterior wire fusion. Group II comprised 15 patients with irreducible AAK, who were treated by transoral odontoid resection. The fixation was done using anterior plating according to Harms in combination with posterior wire fusion according to Brooks. Group III comprised seven patients with CS and additional SAS, who were treated with occipito-cervical fusion. Pre-and postoperatively, evaluation was performed using the parameters pain (visual analog scale), range of motion (ROM), subjective improvement and Health Assessment Questionnaire (HAQ). The neurologic deficit was defined according to the classification proposed by Ranawat. Radiographs including lateral flexion and extension views, and MRI scans were obtained. The average clinical and radiographic follow-up of all patients was 50.7 ± 19.3 months (range 21-96 months). No perioperative fatality occurred. Postoperative pain was significantly relieved in all groups (P < 0.001). In group II a slight improvement in the HAQ was obtained. In groups I and II the ROM of all patients increased significantly (average gain of motion in group I: 11.3°± 7.8°for rotation; 7.8°± 5.6°for bending; average gain of motion in group II: 21.5°± 14.0°f or rotation; 17.2°± 5.5°for bending), while it decreased significantly in group III (10.7°± 18.1°for rotation; 6.7°± 18.5°for bending). Preoperatively 27 patients had a manifest neurologic deficit. At follow-up four patients remained unchanged, all others improved by at least one Ranawat class. All patients, except one, showed solid bony fusion. According to the significantly improved postoperative subjective self-assessment and the clinical and radiological parameters, transoral plate fixation combined with posterior wire fixation after transoral odontoid resection represents an effective reliable and safe procedure for the treatment of irreducible AAK in rheumatoid arthritis.Key words Atlanto-axial instability · Transoral approach · Decompression · Rheumatoid arthritis · C1/C2 fusion ORIGINAL ARTICLE Eur Spine J (1999) 8 : 371-381

show abstract

Transoral Decompression of Atlanto-Axial Dislocation Due to Odontoid Hypoplasia

Cited by 90 publications

References 12 publications

Unstable atlas fracture treatment by anterior plate C1-ring osteosynthesis using a transoral approach

Unstable atlas fracture treatment by anterior plate C1-ring osteosynthesis using a transoral approach

Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update

Stage-related surgery for cervical spine instability in rheumatoid arthritis

Contact Info

Product

Resources

About