Pravin Salunke1, Sushanta Sahoo2, N K Khandelwal3, Mandeep S Ghuman4. 1. Neurosurgery, PGIMER, Chandigarh, India. Electronic address: drpravin_salunke@yahoo.co.uk. 2. Neurosurgery, PGIMER, Chandigarh, India. Electronic address: drsushantsahoo@gmail.com. 3. Radiodiagnosis, PGIMER, Chandigarh, India. Electronic address: nk.khand@gmail.com. 4. Radiodiagnosis, PGIMER, Chandigarh, India. Electronic address: dr.msghuman@gmail.com.
Abstract
OBJECTIVE: Apart from the commonly seen antero-posterior subluxation of C1 over C2, the dislocation may occur in vertical, lateral or rotational plane. Desired C1-2 realignment can be achieved by corrrecting its dislocation in all planes. We describe a technique for the same. MATERIAL AND METHODS: The clinical and radiological features of 16 patients (4 – traumatic and 12 – congenital) with irreducible atlantoaxial dislocation (AAD) admitted in the last 1.5 years were studied. Specific attention was paid to vertical dislocation with lateral and rotational components, apart from anterior-posterior subluxation. They were operated through direct posterior approach. The technique using a long rod holder as lever and screw head (tulip) as fulcrum was employed to achieve C1-2 realignment in all planes. The postoperative clinical and radiological data was analyzed and compared with preoperative data. RESULTS: Patients presented with progressive myelopathy and/or progressive worsening of neck pain. Vertical dislocation was seen in 11 patients with congenital AAD in addition to the antero-posterior subluxation seen in all. Three patients with traumatic AAD and 8 with congenital AAD had additional lateral dislocation or lateral tilt. Three patients with traumatic AAD and 7 with congenital AAD showed rotational component. Postoperatively, all patients showed clinical improvement. CONCLUSIONS: The antero-posterior and vertical realignment could be achieved in all except one. Similarly, rotational and lateral components could be completely corrected in 8 out of 10 patients. The technique appears to realign the C1-2 in all planes and provides good anatomical restoration.
OBJECTIVE: Apart from the commonly seen antero-posterior subluxation of C1 over C2, the dislocation may occur in vertical, lateral or rotational plane. Desired C1-2 realignment can be achieved by corrrecting its dislocation in all planes. We describe a technique for the same. MATERIAL AND METHODS: The clinical and radiological features of 16 patients (4 – traumatic and 12 – congenital) with irreducible atlantoaxial dislocation (AAD) admitted in the last 1.5 years were studied. Specific attention was paid to vertical dislocation with lateral and rotational components, apart from anterior-posterior subluxation. They were operated through direct posterior approach. The technique using a long rod holder as lever and screw head (tulip) as fulcrum was employed to achieve C1-2 realignment in all planes. The postoperative clinical and radiological data was analyzed and compared with preoperative data. RESULTS:Patients presented with progressive myelopathy and/or progressive worsening of neck pain. Vertical dislocation was seen in 11 patients with congenital AAD in addition to the antero-posterior subluxation seen in all. Three patients with traumatic AAD and 8 with congenital AAD had additional lateral dislocation or lateral tilt. Three patients with traumatic AAD and 7 with congenital AAD showed rotational component. Postoperatively, all patients showed clinical improvement. CONCLUSIONS: The antero-posterior and vertical realignment could be achieved in all except one. Similarly, rotational and lateral components could be completely corrected in 8 out of 10 patients. The technique appears to realign the C1-2 in all planes and provides good anatomical restoration.
Authors: Claudio Henrique F Vidal; Ricardo Brandao Fonseca; Bruno Leimig; Walter F Matias-Filho; Geraldo Sa Carneiro-Filho Journal: Surg Neurol Int Date: 2021-06-07