[Transoral approach for the treatment of atlanto-axial dislocation with the Os odontoideum and obstruction of the bilateral vertebral arteries (author's transl)]

Abstract

The two approaches are well-known in the surgical treatment of atlanto-axial dislocation, the one is the anterior and the other is the posterior approach. The indication of these methods is still controversial. This report concerns with one case of atlanto-axial dislocation with the separate odontoid and bilateral obstruction of both vertebral arteries, which was successfully treated by transoral decompression and fusion between the bodies of the atlas and axis. The reasons why we chose this method were: (1) the spinal cord decompression was necessary because of the presence of compression of the cord by the separate odontoid process, (2) the spinal fusion had to be performed to stabilize the atlanto-axial articulation, (3) it was necessary to avoid the damage of collateral circulations to the brainstem through the deep cervical arteries demonstrated by bilat vertebral angiography. The posterior approach is highly susceptible to injure these collateral circulations.