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Video-Assisted Anterior Transcervical Approach for the Reduction of Irreducible Atlantoaxial Dislocation

Liu, Tie MD; Li, Feng MD; Xiong, Wei MD; Du, Xingli MSc; Fang, Zhong MD; Shang, Hui MD; Chen, Anmin MD

Spine:
doi: 10.1097/BRS.0b013e3181c4e048
Surgery
Abstract

Study Design. Technique note.

Objective. To describe a modified minimally invasive approach for the treatment of irreducible atlantoaxial dislocation (IAAD).

Summary of the Background Data. Currently, the most frequently used route for the treatment of symptomatic IAAD is transoral-transpharyngeal approach. Although it provides the most direct route to the atlantoaxial joint, potential problems may arise because of traverse oral cavity, such as the potential risks of infection, postoperative disturbances of breathing, and swallowing. The aim of this study was to describe a less-invasive approach for IAAD.

Methods. Four consecutive patients with IAAD underwent the combined video-assisted atlantoaxial transcervical release (VAAT) procedure and posterior occipital-cervical fusion or C1–C2 screw fixation at Tongji Hospital. Clinical characteristics, images data, operative variables, and follow-up data were recorded.

Results. Four cases presented with signs and symptoms of spinal cord dysfunction caused by IAAD underwent 1-stage anterior release, reduction, and posterior fixation. Three cases received C1–C2 screw fixation, and 1 case with occipitocervical fixation. Postoperative imaging studies showed that complete decompression was achieved in all the cases. No systemic infections, cerebrospinal fluid leaks, or adverse neurologic sequelae were found. None of the patients required prolonged intubation, tracheostomy, or enteral tube feeding. All patients started to oral intake after anesthesia. Neurologic status in 1 case remained at baseline whereas it improved in the others. The mean follow-up period was 9 months (6∼12 months). All cases achieved solid fusion, without implants failure.

Conclusion. Our initial experience showed that the VAAT procedure for IAAD is a safe supplement and alternative to conventional and transcervical procedures.

In Brief

To describe a modified minimally invasive approach for the treatment of irreducible atlantoaxial dislocation (IAAD). Four cases with IAAD were treated by VAAT procedures with satisfied results. Our initial experience shows that the VAAT approach for IAAD is a safe supplement and alternative to conventional and transcervical procedures.

Author Information

From the Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.

Acknowledgment date: June 16, 2009. Revision date: August 29, 2009. Acceptance date: September 8, 2009.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

Funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Supported by the National Science Foundation of China (NSFC) grant No. 30772206.

Address correspondence and reprint requests to Feng Li, Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road 1095, Wuhan, Hubei, People's Republic of China; E-mail: lifengtongji@yahoo.cn or lifeng6311@yahoo.com.cn.

© 2010 Lippincott Williams & Wilkins, Inc.