Treatment of basilar invagination with atlantoaxial dislocation: atlantoaxial joint distraction and fixation with transoral atlantoaxial reduction plate (TARP) without odontoidectomy

Xia, Hong; Yin, Qudong; Ai, Fuzhi; Ma, Xiangyang; Wang, Jianhua; Wu, Zenghui; Zhang, Kai; Liu, Jingfa; Xu, Junjie

doi:10.1007/s00586-014-3378-8

Cited by 40 publications

(28 citation statements)

References 23 publications

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“…Anterior transoral approach decompression or odontoid resection combined with posterior fixation are common techniques, but they have many drawbacks, including the deep and narrow surgical field, poor exposure of the odontoid, cerebrospinal fluid leakage, intracranial infection, high incidence of oropharyngeal dysfunction, risk of neurological deterioration, and even sudden death (23,27,31). Moreover, transoral decompression itself may also worsen atlantoaxial stability, leading to increases in translation and range of motion (ROM) in all movements except axial rotation.…”

Section: █ Discussionmentioning

confidence: 99%

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Surgical management of adult reducible atlantoaxial dislocation, basilar invagination and chiari malformation with syringomyelia

Gong

Liu²,

Chen³

et al. 2015

Turkish Neurosurgery

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ABSTRACTand nervous elements within this region, any congenital malformation of one tissue may cause a wide spectrum of neurological deficit, especially the compression of medulla oblongata, which may lead to serious consequences.Appropriate and timely diagnosis and treatment of these malformations are of great significance. However, there is still lack of an ideal method to cure all of these malformations. Anterior transoral decompression at the CVJ can occur in many types of pathology, including malformation (e.g., basilar invagination, atlas assimilation, os odontoideum, atlantoaxial █ INTRODUCTIONCraniovertebral junction (CVJ) malformations include bone, soft tissue, and neural structure malformations. AAD, BI and AOL are the most commonly encountered bone malformations, and CHM is the most common of the nervous structure malformations. The CVJ is an anatomical complex formed by the basis of the occipital bone, clivus, foramen magnum, and upper cervical vertebrae, their ligaments, and the vascular and nervous tissues passing through these bony structures (9). Because of the special relation of the bony, vascular AIM: To analyze retrospectively the surgical management of reducible atlantoaxial dislocation (AAD), basilar invagination (BI) and Chiari malformation (CHM) with syringomyelia through a single-stage posterior approach. MATERIAL and METHODS:Forty-three patients with reducible AAD, BI and CHM with syringomyelia underwent surgery from January 2009 to January 2013. Intraoperative restoration followed by posterior decompression and plate-rod placement with occipital cortical screws and C2/C3 lateral mass cortical screws fixation devices were used in all patients. Results were recorded both pre-and postoperatively and these outcome measures included Nurick grading (NG) and radiology findings (atlantodental interval (ADI), space available for the spinal cord (SAC), interval between odontoid and Chamberlain's line (IOC), and the cervicomedullary angle (CMA)). RESULTS:Forty (93%) of the 43 patients were followed up. Thirty-six (90%) patients' symptoms improved and four (10%) stabilized. No patients became progressively worse. The difference between preoperative and postoperative Nurick grades was statistically significant. All patients achieved restoration, including thirty (75%) patients had full restoration and ten (25%) had part restoration. The size of syringomyelia was obviously decreased in 32 (80%) patients and stable in 8 (20%) patients. All radiology findings (ADI, IOC, SAC, CMA) showed significant changes from pre-to postoperative (p < 0.01). CONCLUSION:Intraoperative distraction, extension combined posterior decompression with use of plate-rod-screws occipitocervical fusion device is an effective method to treat AAD, BI and CHM with syringomyelia.

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Section: █ Discussionmentioning

confidence: 99%

“…fixed dislocation), tumor, trauma, chronic inflammatory diseases (most frequently rheumatoid arthritis), and osteomyelitis (6,7,14,31). Transoral approaches can directly access the lesion site, away from laterally placed neurovascular structures (2,25).…”

mentioning

confidence: 99%

Surgical management of adult reducible atlantoaxial dislocation, basilar invagination and chiari malformation with syringomyelia

Gong

Liu²,

Chen³

et al. 2015

Turkish Neurosurgery

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“…Transoral odontoidectomy is a high risk procedure that can lead to post-operative CSF leakage, meningitis, and death [10]. Additionally, posterior surgeries are difficult to perform on patients with C1 posterior arch deformities and congenital small pedicles [11]. Goel et al, have reported the successful employment of a direct posterior reduction without decompression in the case of fixed IAAD with os odontoideum or odontoid fracture [12].…”

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confidence: 99%

“…In 2005, a transoral atlantoaxial reduction plate, or TARP, was first used to repair basilar invagination with irreducible atlantoaxial dislocation [11]. The use of a TARP allows the relocation of the odontoid to be performed in one step without the need for a posterior operation [11]. Such a procedure could reduce complications that occur in a two-step method [11].…”

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Surgical Management of Irreducible Atlantoaxial Dislocation

Passias

Worley²,

Jalai³

2014

Orthop Muscul Syst

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The classification and treatment of atlantoaxial dislocations (AAD) remains controversial. Despite existing debate among the literature, it is generally accepted that the treatment of symptomatic AAD should be surgical reduction and fixation. More recently, there has also been acknowledgement among treating surgeons that there are substantial differences between irreducible and reducible AAD, with significant differences between the two groups in terms of the severity of clinical presentation and ideal management [1]. Presently, however, there is little agreement on how best to manage IAAD. Specifically, the importance of anatomical reduction and the method of obtaining proper alignment surgically varies based on the treating surgeon and institution. The purpose of this commentary is to briefly discuss current options for the surgical management of IAAD.

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Congenital Disorders of the Skull Base

König

2017

Surgery of the Skull Base

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Treatment of basilar invagination with atlantoaxial dislocation: atlantoaxial joint distraction and fixation with transoral atlantoaxial reduction plate (TARP) without odontoidectomy

Cited by 40 publications

References 23 publications

Surgical management of adult reducible atlantoaxial dislocation, basilar invagination and chiari malformation with syringomyelia

Surgical management of adult reducible atlantoaxial dislocation, basilar invagination and chiari malformation with syringomyelia

Surgical Management of Irreducible Atlantoaxial Dislocation

Congenital Disorders of the Skull Base

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