Transoral release to realign postoperative loss of reduction following occipitocervical fixation for congenital basilar invagination

2021 ◽  
Author(s):  
Ajinkya Achalare ◽  
Kshitij Chaudhary ◽  
Arjun Dhawale ◽  
Vicky Khattar ◽  
Bachi Hathiram
Keyword(s):  
Basilar Invagination ◽  
Occipitocervical Fixation ◽  
Loss Of Reduction

scholarly journals Surgical treatment for basilar invagination with irreducible atlantoaxial dislocation: transoral atlantoaxial reduction plate fixation vs occipitocervical fixation

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaobao Zou ◽  
Bieping Ouyang ◽  
Haozhi Yang ◽  
Binbin Wang ◽  
Su Ge ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Early Stage ◽  
Plate Fixation ◽  
Japanese Orthopaedic Association ◽  
Odontoid Process ◽  
Basilar Invagination ◽  
Atlantoaxial Dislocation ◽  
Clinical Effects ◽  
Occipitocervical Fixation ◽  
Irreducible Atlantoaxial Dislocation

Abstract Background Transoral atlantoaxial reduction plate (TARP) fixation or occipitocervical fixation (OF) is an effective treatment for basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD). But, all current clinical studies involved a single surgical procedure. The clinical effects of TARP and OF operation for BI with IAAD have yet to be compared. We therefore present this report to compare the treatment of TARP and OF procedure for BI with IAAD. Methods Fifty-six patients with BI with IAAD who underwent TARP or OF operation from June 2011 to June 2017 were retrospectively analyzed. Among these, 35 patients underwent TARP operation (TARP group), and 21 patients underwent OF operation (OF group). We compared the difference of clinical, radiological, and surgical outcomes between the TARP and OF groups postoperatively. Results Compared with OF group, the operative time and blood loss in TARP group were lower. There was no statistical difference in the atlantodental interval (ADI), clivus canal angle (CCA), cervicomedullary angle (CMA), distance between the top of the odontoid process and the Chamberlain line (CL) and Japanese Orthopaedic Association (JOA) score between the TARP and OF groups preoperatively, but the improvements of these parameters in the TARP group were superior to those in the OF group postoperatively. The fusion rates were higher in the TARP group than those in the OF group at the early stage postoperatively. Conclusions TARP and OF operations are effective surgical treatment for BI with IAAD, but the performance of reduction and decompression and earlier bone fusion rates of TARP procedure are superior to those of OF.

Basilar invagination: craniocervical instability treated with cervical traction and occipitocervical fixation

2007 ◽  
Vol 7 (4) ◽  
pp. 444-449 ◽  
Author(s):  
Ricardo V. Botelho ◽  
Eliseu B. Neto ◽  
Gustavo C. Patriota ◽  
Jefferson W. Daniel ◽  
Paulo A. S. Dumont ◽  
...  
Keyword(s):  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Vertical Position ◽  
Occipitocervical Fixation ◽  
Cervical Traction ◽  
Craniocervical Instability

✓ The upward odontoid displacement observed in basilar invagination (BI) is generally associated with a horizontal clivus and craniocervical kyphosis, conditions that exert ventral compression at the spinomedullary junction. Ventral brainstem decompression by reduction or elimination of the odontoid invagination is part of the desired treatment. The authors describe a case of BI in an adult, who was effectively treated with the easy and safe reduction of odontoid invagination via cervical traction. Normalization of kyphosis at the craniovertebral junction and the vertical position of both a previously horizontal clivus and the cerebellar tentorium demonstrated that these conditions were not part of the original malformation but instead were caused by a reducible craniovertebral instability.

Posterior occipitocervical (C0–3) fusion using polyaxial occipital condyle to cervical spine screw and rod fixation: a radiographic and cadaveric analysis

2010 ◽  
Vol 12 (5) ◽  
pp. 509-516 ◽  
Author(s):  
Bruce M. Frankel ◽  
Michael Hanley ◽  
Alex Vandergrift ◽  
Timothy Monroe ◽  
Steven Morgan ◽  
...  
Keyword(s):  
Sagittal Plane ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Atlantoaxial Instability ◽  
Occipital Condyle ◽  
Anatomical Studies ◽  
Occipitocervical Fixation ◽  
Polyaxial Screws ◽  
Occipital Condyles ◽  
Ct Studies

Numerous conditions affect the occipitocervical junction requiring treatment with occipitocervical fixation. In this paper the authors present their technique of craniocervical fixation achieved with the cephalad extension of posterior C1–3 polyaxial screw and rods to polyaxial screws placed in the occipital condyles. They retrospectively analyzed occipital condyle morphology obtained from CT analyses of 40 patients with normal cervical spines, evaluated occipital condyle screw placement feasibility in 4 cadavers, and provided a case report of a 70-year-old woman with rheumatoid arthritis, basilar invagination, and atlantoaxial instability who was treated with this novel technique. Based on radiographic analysis of occipital condyle anatomy, they concluded that on average a 3.5-mm-diameter × 20- to 30-mm-long screw can be safely placed at an angle of 20–33° from the sagittal plane. Overall, measuring the condylar heights (mean [± SD] 10.8 ± 1.5 mm, range 8.1–15.0 mm), widths (mean 11.1 ± 1.4 mm, range 8.5–14.2 mm), lengths (20.3 ± 2.1 mm, range 15.4–24.6 mm), and angles (mean 32.8 ± 5.2°, range 20.2–45.8°) by using CT studies is an accurate and precise method. This finding correlates with the results of prior anatomical studies of occipital condyles and is important in the planning of craniovertebral junction surgery.

scholarly journals Increase of the clivus-canal angle in patients with basilar invagination, without atlantoaxial displacement, treated with a simple maneuver of indirect decompression of the odontoid with the head clamp, during posterior occipitocervical arthrodesis

2021 ◽  
Vol 12 ◽  
pp. 260
Author(s):  
Claudio Henrique F. Vidal ◽  
Ricardo Brandao Fonseca ◽  
Bruno Leimig ◽  
Walter F. Matias-Filho ◽  
Geraldo Sa Carneiro-Filho
Keyword(s):  
Postoperative Period ◽  
Posterior Approach ◽  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Foramen Magnum ◽  
Occipitocervical Fixation ◽  
Significant Difference ◽  
Indirect Decompression ◽  
Head Clamp

Background: Basilar invagination (BI) can be defined as the insinuation of the content of the craniovertebral junction through the foramen magnum toward the posterior fossa. BI is a prevalent condition in Northeast Brazil. The present study describes the changes in the clivus-canal angle (CCA) in the postoperative period in patients with symptomatic BI operated by a posterior approach, using a simple technique of indirect reduction of the odontoid associated with occipitocervical fixation. Methods: Patients underwent radiological evaluations by magnetic resonance imaging in the pre and postoperative periods, where the height of the odontoid tip was measured in relation to the Chamberlain line and the ACC. All patients underwent posterior occipitocervical fixation with specific maneuvers of distraction and extension of the cephalic segment with the aid of a head clamp with three fixation points for anterior reduction of the odontoid. Results: Among the 8 patients evaluated in the series, all had increased ACC in the postoperative period, with a mean of 14.81 ± 1.54°, and statistically significant difference between the pre and postoperative periods (P < 0.05). Conclusion: The indirect surgical reduction of the odontoid process by a posterior approach through the manipulation (distraction-extension) of a “Mayfield” type of head clamp followed by occipitocervical fixation proved to be effective in improving the ACC, being easily reproducible.

Endoscopic Transnasal Transclival Odontoidectomy: A New Approach to Decompression: Technical Case Report

2008 ◽  
Vol 63 (suppl_1) ◽  
pp. ONSE92-ONSE94 ◽  
Author(s):  
Jau-Ching Wu ◽  
Wen-Cheng Huang ◽  
Henrich Cheng ◽  
Muh-Lii Liang ◽  
Ching-Yin Ho ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
New Approach ◽  
Prolonged Intubation ◽  
Less Invasive ◽  
Transoral Odontoidectomy ◽  
Occipitocervical Fixation ◽  
Lateral Mass Screws

Abstract Objective: Endoscopic transnasal transclival resection of the odontoid process is less invasive than the standard transoral odontoidectomy. In this article, we describe our techniques, which are less invasive but provide successful decompression. Clinical Presentation: From September 2004 to April 2007, three consecutive patients with basilar invagination and instability in the craniovertebral junction were enrolled. The causes for the invagination and instability included rheumatoid arthritis in two patients and trauma in one patient, and all patients presented with myelopathy and quadriparesis before intervention. Intervention: All three patients underwent an endoscopic transnasal transclival approach for anterior decompression and resection of the displaced odontoid process and pannus to decompress the underlying medulla. Subsequently, they received occipitocervical fixation by lateral mass screws and bone fusion to ensure stability. Remarkable neurological recovery was observed after surgery in all patients, and no adverse effects were noted. Conclusion: Compared with the standard transoral approach, the transnasal transclival endoscopic approach for decompressing basilar invagination is a feasible and effective alternative that avoids common disadvantages like prolonged intubation, excessive tongue retraction, and the need for palatal incision.

Further cranial settling of the upper cervical spine following odontoidectomy

2001 ◽  
Vol 95 (2) ◽  
pp. 246-249 ◽  
Author(s):  
Sait Naderi ◽  
M. Necmettin Pamir
Keyword(s):  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Upper Cervical Spine ◽  
Rigid Fixation ◽  
Content Type ◽  
Fusion Procedure ◽  
Transoral Odontoidectomy ◽  
Occipitocervical Fixation ◽  
Additional Surgery ◽  
Upper Cervical

✓ A variety of diseases may affect the craniovertebral junction and require a decompressive and fusion procedure. Craniovertebral junction instability is expected after a fusion procedure. The authors describe two patients with basilar invagination who underwent transoral odontoidectomy and occipitocervical fixation. Despite an uneventful immediate postoperative course, further cranial settling of the C-2 vertebral body (VB) was demonstrated. One patient experienced neurological deterioration and required a second decompressive procedure, whereas the second patient was asymptomatic and required no additional surgery. It was concluded that the odontoidectomy may have led to horizontal separation of the C-1 lateral masses, resulting in further cranial settling of the C-2 VB. Preservation of one aspect of the C-1 anterior arch minimizes C-1 lateral mass offset and, in turn, further cranial settling of the C-2 VB. In addition, a more rigid fixation of C-2 may minimize the possibility of horizontal separation of the C-1 lateral masses after transoral odontoidectomy.

scholarly journals Craniocervical fixation using inside-outside instrumentation

2005 ◽  
Vol 24 (04) ◽  
pp. 157-162
Author(s):  
José Alberto Landeiro ◽  
Bruno C. da Rocha Lázaro ◽  
Igor de Castro
Keyword(s):  
Cervical Spine ◽  
Basilar Invagination ◽  
Craniocervical Junction ◽  
Clinical Knowledge ◽  
Fixation Technique ◽  
Occipitocervical Fixation ◽  
Pars Interarticularis ◽  
Flat Portion ◽  
Axis Body ◽  
Transoral Resection

AbstractThe clinical knowledge of biomechanics of atlantoaxial complex demonstrated that progressive instability tipically occurs after anterior decompression of the craniocervical junction. We report the so-called inside-outside technique for occipitocervical fixation, originally described by Pait et al. applied in two patients. One patient with rheumatoid artrhitis underwent a transoral resection of basilar invagination; in another case the craniocervical junction instability was due to the presence of tumor. The “inside-outside” occipitocervical fixation technique consists in the use of a titanium rod bended according with occipital cervical angle, placed and fixed laterally over the cervical spine. The rod is fixed to the occipital bone using a screw with the flat portion positioned onto the epidural space. In the cervical spine the rod is attached to transarticular screws placed at the superolateral quadrant of the articular mass. In the axis the screw is introduced through the pars interarticularis finishing at the axis body or the lateral mass of the atlas. In both patients, stabilization was achieved immediately. This technique proved to be safe and easily applied in the patients who developed instability in the craniocervical junction procedure.

Treatment of Basilar Invagination With Klippel-Feil Syndrome

Neurosurgery ◽  
2015 ◽  
Vol 78 (4) ◽  
pp. 492-498 ◽  
Author(s):  
Gejin Wei ◽  
Zhiyun Wang ◽  
Fuzhi Ai ◽  
Qingshui Yin ◽  
Zenghui Wu ◽  
...  
Keyword(s):  
Wide Spectrum ◽  
Odontoid Process ◽  
Clinical Results ◽  
Basilar Invagination ◽  
Neurological Deficits ◽  
Cervical Cord ◽  
Japanese Orthopedic Association ◽  
Hardware Failure ◽  
Occipitocervical Fixation ◽  
Upper Cervical

Abstract BACKGROUND: Klippel-Feil syndrome (KFS) is characterized by congenital vertebral fusion of the cervical spine and a wide spectrum of associated anomalies. In patients with KFS with basilar invagination (BI), compression of the brainstem and upper cervical cord results in neurological deficits, and decompression and occipitocervical reconstruction are required. The highly varied anatomy of KFS makes a posterior occipitocervical fixation strategy challenging. For these patients, the transoral atlantoaxial reduction plate (TARP) operation is an optimal option to perform a direct anterior fixation to achieve stabilization. OBJECTIVE: To evaluate the effectiveness of TARP internal fixation for the treatment of BI with KFS. METHODS: Ten consecutive patients with BI and KFS who underwent TARP reduction and fixation from 2010 to 2012 were reviewed. Clinical assessment and image measurements were performed preoperatively and at the most recent follow-up. Nine patients (9/10) were followed for an average of 31.44 months. RESULTS: Symptoms were alleviated in 9 of 9 patients (100.00%). The odontoid process was ideally corrected with the TARP system. The mean clivus canal angle improved from 124° preoperatively to 152° postoperatively. The average preoperative and postoperative Japanese Orthopedic Association scores were 10.56 (n = 9) and 14.67 (n = 9), respectively, indicating 63.82% improvement. There was bony bridge catenation on the computed tomography scans and no evidence of hardware failure at 6 months. CONCLUSION: The TARP operation is effective and safe for treating patients with BI with KFS. The midterm clinical results were satisfactory.

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