Revision surgery in an irreducible atlantoaxial dislocation (IAAD) previously operated with a posterior approach is challenging. Multiple modalities using anterior, posterior, and dual approaches have been described. We report a so far unreported technique of revision surgery by posterior implant removal and decompression with anterior transoral release followed by posterior instrumentation.
14-year male with basilar invagination (BI) with IAAD, previously operated with posterior decompression and instrumented occipitocervical fusion presented three months later with post-traumatic recurrence of myelopathy with quadriparesis with Di Lorenzo grade 4 and loss of reduction. He was operated with a posterior implant and early fusion mass removal with extended foramen magnum decompression (FMD), followed by anterior transoral release with a satisfactory reduction on traction, and finally, a posterior revision instrumented occipitocervical fusion.
At 2-year follow-up, the patient was symptom-free with Di Lorenzo grade 1 and cervicomedullary angle improvement from 97.4° to 141.2°; achieving bony fusion.
Single-stage posterior-anterior transoral-posterior approach can be used to achieve satisfactory reduction for a revision BI with IAAD with prior posterior instrumentation.
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Dr Milind Bhise, Department of Anaesthesiology and Dr Kiran Sathe, Department of Pediatrics, Sir H.N. Reliance Foundation Hospital, Mumbai.
There was no financial support or sources of funding for this study.
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There are no conflicts of interest and none of the authors have any disclosures.
Ethics approval was waived by the Institutional Research Ethics Committee of Sir H.N. Reliance Hospital in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.
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Achalare, A., Chaudhary, K., Dhawale, A. et al. Transoral release to realign postoperative loss of reduction following occipitocervical fixation for congenital basilar invagination. Spine Deform (2021). https://doi.org/10.1007/s43390-021-00303-9