Ajinkya Achalare1, Kshitij Chaudhary1, Arjun Dhawale2,3, Vicky Khattar4, Bachi Hathiram4. 1. Department of Orthopaedics, Sir H.N. Reliance Foundation Hospital, Prarthana Samaj, Girgaon, Mumbai, 400004, India. 2. Department of Orthopaedics, Sir H.N. Reliance Foundation Hospital, Prarthana Samaj, Girgaon, Mumbai, 400004, India. arjundhawale@hotmail.com. 3. Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai, India. arjundhawale@hotmail.com. 4. Department of Otorhinolaryngology, Sir H.N. Reliance Foundation Hospital, Girgaon, Mumbai, India.
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.
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.