Surgical techniques and preliminary results.
To describe and evaluate the safety and efficacy of a new minimal invasive
technique for the irreducible atlantoaxial dislocation
Summary of Background Data
Endoscope has been widely used in minimal invasive
spinal surgery. However, there are no clinical reports regarding anterior
approach for IADD in the literature.
Ten consecutive patients with IADD were treated by anterior
release with microendoscopic aide and subsequently reduction, anterior transarticular screw
fixation and morselized autologous bone grafts. There were 3 cases of odontiod dysplasia, 4, chronic odontiod fracture, 1, odontiod absence, 1 fasilar impression, and 1 malunion of odontoid fracture. According to Symon and Lavender's classification of disability, 6 cases were moderate disability, 3 severe nonbedbound, and 1 severe bedridden. The procedure was performed by the same surgeon (Yong-Long Chi).
The new technique was performed successfully in all cases. All the patients underwent transarticular screw
fixation and anterior morselized autograft
fusion. The average operation time was 120 min (range, 90 to 150 min) and the mean estimated blood loss was 150 mL (range, 100 to 250 mL). Postoperative radiographs demonstrated that 9 cases restored anatomic position and 1 had partial reduction. According to the postoperative computed tomography all the screws were appropriately placed. Follow-up after surgery, longest is 16 months and minimal 8 months with a mean of 12 months, neurologic status was improved in all patients. There was no loss of fixation and solid fusion was achieved in all cases.
Surgical technique of microendoscopic anterior
release, reduction, fixation, and fusion is safe and reliable minimally invasive for treating IADD.