Advertisement

A modified microsurgical interfacet release and direct distraction technique for management of congenital atlantoaxial dislocation: technical note

  • GuoSong Shang
  • Tao FanEmail author
  • Zhe Hou
  • Cong Liang
  • YinQian Wang
  • XinGang Zhao
  • Wayne Fan
Technical Note

Abstract

Various techniques have been used for management of congenital atlantoaxial dislocation. Recently, the reduction of atlantoaxial dislocation through a single posterior approach has attracted more and more attention. Here, we present a modified technique including direct interfacet release and distraction between C1 and C2 by a specially designed distractor, posterior internal fixation and bone graft fusion. The illustrated technique was performed in 15 consecutive patients, and the outcomes were recorded and analyzed. Follow-up ranged from 12 to 26 months. Clinical symptoms improved in 14 patients (93.3%) and were stable in 1 patient (6.7%). Radiologically, 60–100% reduction was achieved in 13 patients (86.6%). Bone fusion was obtained in all patients at 12 months after the operation. The two-tailed Wilcoxon signed-rank test was used to analyze the preoperative and postoperative Japanese Orthopedic Association scores (JOA), atlas-dens interval (ADI), and cervicomedullary angle (CMA) (P < 0.001). Our results suggested that this direct interfacet release and distraction technique with a specially designed C1–2 distractor can provide a definite effective C1–2 facet distraction and odontoid process restoration through a single posterior approach.

Keywords

Atlantoaxial dislocation Odontoid process Interfacet distraction 

Notes

Financial support

This study was funded by the Construction Project of National Clinical Key Specialties of People’s Republic of China [Ministry of Health of People’s Republic of China 873 (2011)] and the Capital Health Research and Development of Special 2014-2-8011. The corresponding author, Tao Fan, received the support of these funding sources.

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. This article does not contain any studies with human participants performed by any of the authors.

Conflict of interest

The authors declare that they have no conflicts of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Dickman CA, Sonntag VK, Papadopoulos SM, Hadley MN (1991) The interspinous method of posterior atlantoaxial arthrodesis. J Neurosurg 74:190–198.  https://doi.org/10.3171/jns.1991.74.2.0190 CrossRefGoogle Scholar
  2. 2.
    Goel A (2004) Treatment of basilar invagination by atlantoaxial joint distraction and direct lateral mass fixation. J Neurosurg Spine 1:281–286.  https://doi.org/10.3171/spi.2004.1.3.0281 CrossRefGoogle Scholar
  3. 3.
    Goel A (2014) Facetal alignment: basis of an alternative Goel’s classification of basilar invagination. J Craniovertebr Junction Spine 5:59–64.  https://doi.org/10.4103/0974-8237.139199 CrossRefGoogle Scholar
  4. 4.
    Goel A, Laheri V (1994) Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir 129:47–53CrossRefGoogle Scholar
  5. 5.
    Jain VK, Takayasu M, Singh S, Chharbra DK, Sugita K (1993) Occipital-axis posterior wiring and fusion for atlantoaxial dislocation associated with occipitalization of the atlas. Technical Note. J Neurosurg 79:142–144.  https://doi.org/10.3171/jns.1993.79.1.0142
  6. 6.
    Jeanneret B, Magerl F (1992) Primary posterior fusion C1/2 in odontoid fractures: indications, technique, and results of transarticular screw fixation. J Spinal Disord 5:464–475CrossRefGoogle Scholar
  7. 7.
    Jian FZ, Chen Z, Wrede KH, Samii M, Ling F (2010) Direct posterior reduction and fixation for the treatment of basilar invagination with atlantoaxial dislocation. Neurosurgery 66:678–687; discussion 687.  https://doi.org/10.1227/01.Neu.0000367632.45384.5a CrossRefGoogle Scholar
  8. 8.
    Lee ST, Fairholm DJ (1985) Transoral anterior decompression for treatment of unreducible atlantoaxial dislocations. Surg Neurol 23:244–248CrossRefGoogle Scholar
  9. 9.
    Magerl F, Seemann PS (1987) Stable posterior fusion of the atlas and axis by transarticular screw fixation. In: Kehr P, Weidner A (eds) Cervical spine. Springer, Wien, pp 322–327Google Scholar
  10. 10.
    O'Brien JR, Gokaslan ZL, Riley LH III, Suk I, Wolinsky JP (2008) Open reduction of C1-C2 subluxation with the use of C1 lateral mass and C2 translaminar screws. Neurosurgery 63:ONS95–ONS98; discussion ONS98–99.  https://doi.org/10.1227/01.neu.0000335021.14112.2e Google Scholar
  11. 11.
    Wang C, Yan M, Zhou HT, Wang SL, Dang GT (2006) Open reduction of irreducible atlantoaxial dislocation by transoral anterior atlantoaxial release and posterior internal fixation. Spine (Phila Pa 1976) 31:E306–E313.  https://doi.org/10.1097/01.brs.0000217686.80327.e4 CrossRefGoogle Scholar
  12. 12.
    Yadav YR, Ratre S, Parhihar V, Dubey A, Dubey NM (2017) Endoscopic technique for single-stage anterior decompression and anterior fusion by transcervical approach in atlantoaxial dislocation. Neurol India 65:341–347.  https://doi.org/10.4103/neuroindia.NI_1276_16 CrossRefGoogle Scholar
  13. 13.
    Yin Q, Ai F, Zhang K, Chang Y, Xia H, Wu Z, Quan R, Mai X, Liu J (2005) Irreducible anterior atlantoaxial dislocation: one-stage treatment with a transoral atlantoaxial reduction plate fixation and fusion. Report of 5 cases and review of the literature. Spine (Phila Pa 1976) 30:E375–E381CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Neurosurgery, Linfen People’s HospitalShanxi Medical UniversityLinfenPeople’s Republic of China
  2. 2.Spine Center, Sanbo Brain HospitalCapital Medical UniversityHaidian DistrictPeople’s Republic of China
  3. 3.Department of Neurosurgery, Beijing Luhe HospitalCapital Medical UniversityTongzhou DistrictPeople’s Republic of China
  4. 4.Faculty of ScienceUniversity of British ColumbiaVancouverCanada

Personalised recommendations