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. 2021 Jul;9(4):1197-1205.
doi: 10.1007/s43390-021-00303-9. Epub 2021 Feb 15.

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

Ajinkya Achalare  1 , Kshitij Chaudhary  1 , Arjun Dhawale  2   3 , Vicky Khattar  4 , Bachi Hathiram  4
Affiliations

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

Ajinkya Achalare et al. Spine Deform. 2021 Jul.

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusion: Single-stage posterior-anterior transoral-posterior approach can be used to achieve satisfactory reduction for a revision BI with IAAD with prior posterior instrumentation.

Keywords: Atlantoaxial; Dislocation; IAAD; Instability; Irreducible; Revision.

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References

    1. Goel A (2004) Treatment of basilar invagination by atlantoaxialjoint distraction and direct lateral mass fixation. J Neurosurg Spine 1:281–286. https://doi.org/10.3171/spi.2004.1.3.0281 - DOI - PubMed
    1. Srivastava SK, Aggarwal RA, Nemade PS et al (2016) Single-stage anterior release and posterior instrumented fusion for irreducible atlantoaxial dislocation with basilar invagination. Spine J 16(1):1–9 - DOI
    1. Tan M, Jiang X, Yi P et al (2011) Revision surgery of irreducible atlantoaxial dislocation: a retrospective study of 16 cases. Eur Spine J 20(12):2187–2194. https://doi.org/10.1007/s00586-011-1865-8 - DOI - PubMed - PMC
    1. Hedequist D, Bekelis K, Emans J, Proctor MR (2010) Single stage reduction and stabilization of basilar invagination after failed prior fusion surgery in children with Down’s syndrome. Spine 35(4):E128–E133. https://doi.org/10.1097/brs.0b013e3181bad0c2 - DOI - PubMed
    1. Yang J, Ma X, Xia H, Wu Z, Ai F, Yin Q (2014) Transoral anterior revision surgeries for basilar invagination with irreducible atlantoaxial dislocation after posterior decompression: a retrospective study of 30 cases. Eur Spine J 23(5):1099–1108. https://doi.org/10.1007/s00586-014-3169-2 - DOI - PubMed

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