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Spinal Deformity pp 17–27Cite as

Transoral Odontoidectomy and C1-2 Posterior Fusion Complication

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Abstract

Atlantoaxial instability results from the loss of the structural integrity of the C1–C2 articulation. Loss of alignment of the C1–C2 joint puts the neurovascular structures—the spinal cord at the cervicomedullary junction and the vertebral arteries—at risk for injury. Treatment is focused on restoring proper alignment, decompressing the neural elements, and stabilizing the joint with instrumentation so that bony fusion can occur. The case presented here is of a 67-year-old osteoporotic male with a traumatic dens fracture and C1–C2 subluxation, resulting in spinal cord compression, and vertebral artery dissection. Halo traction was initially pursued to realign the C1–C2 joint, but the patient had a skull fracture from the halo fixation pins. The patient’s halo was repositioned, and he underwent a posterior occipital-cervical instrumentation. He then underwent a transoral odontoidectomy which was complicated by durotomy. Strategies for surgical management and the spectrum of surgical complications are presented.

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Authors and Affiliations

  1. Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, 94143, USA

    Andrew K. Chan, Michael S. Virk & Andres J. Aguirre

  2. Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, 94143, USA

    Praveen V. Mummaneni

Authors
  1. Andrew K. Chan
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  2. Michael S. Virk
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  3. Andres J. Aguirre
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  4. Praveen V. Mummaneni
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Corresponding author

Correspondence to Praveen V. Mummaneni .

Editor information

Editors and Affiliations

  1. Joan O’Reilly Endowed Professor in Spinal Surgery, Vice Chairman, Department of Neurosurgery, University of California, San Francisco, California, USA

    Praveen V. Mummaneni

  2. Professor, Director of Spinal Surgery, Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA

    Paul Park

  3. University of Louisville, Norton Leatherman Spine Center, Louisville, Kentucky, USA

    Charles H. Crawford III

  4. Chief, Division of Spine Surgery, Associate Professor of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

    Adam S. Kanter

  5. Department of Orthopedic Surgery, University of Louisville, Norton Leatherman Spine Center, Louisville, Kentucky, USA

    Steven D. Glassman

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Chan, A.K., Virk, M.S., Aguirre, A.J., Mummaneni, P.V. (2018). Transoral Odontoidectomy and C1-2 Posterior Fusion Complication. In: Mummaneni, P., Park, P., Crawford III, C., Kanter, A., Glassman, S. (eds) Spinal Deformity . Springer, Cham. https://doi.org/10.1007/978-3-319-60083-3_3

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  • DOI: https://doi.org/10.1007/978-3-319-60083-3_3

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-60082-6

  • Online ISBN: 978-3-319-60083-3

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