Case series of clinical study and surgical management of atlanto axial dislocation our institute experience

Authors

  • Ravi Dasari Department of Neurosurgery, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
  • K. Satyavara Prasad Department of Neurosurgery, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
  • B. Sandeep Department of Neurosurgery, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
  • B. V. S. Raman Department of Neurosurgery, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20170951

Keywords:

Atlanto axial dislocation, Cervico medullary junction, Odentoid

Abstract

Background: Atlantoaxial dislocation refers to a loss of stability between the atlas and axis (C1-C2), resulting in loss of normal articulation. Cervical spine C1-C2 motion segment is the most technically challenging.

Methods: This is a prospective and retrospective Study which included 34 patients admitted in King George hospital, Andhra medical college, Visakhapatnam over the past two years (January 2014- January 2016) with AAD.

Results: The age of the patients ranged from 3 to 60 years with mean age being 37.67 years. Commonest presenting sign is local tenderness at the back of upper cervical region in 91.17%. Most common procedure done was single sitting trans oral odontoid decompression with posterior occipito cervical fusion with occipital plate and C2, C4 polyaxial screws and lateral mass rods in 18 cases out of 34. The next common procedure performed was C1 lateral mass and C2 pars screw fixation 8 out of 34.

Conclusions: Trans oral odentoidectomy and posterior ocipito cervical fusion is ideal and still holds good for irreducible AAD with  ventral compressive pathology.

References

Subin B, Liu JF, Marshall GJ, Huang HY, Ou JH, Xu GZ. Transoral anterior decompression and fusion of chronic irreducible atlantoaxial dislocation with spinal cord compression. Spine (Phila Pa 1976).1995;20(11):1233-40.

Beyazal MS, Demirok D, Çapkın E, Usul H, Tosun M, Sarı A. Grisel’s syndrome: a case report. Turkish J Rheumatol. 2011;26(3):243-7.

Kökse T, Dilek I, Ciklatekerlioclu O, Beoük A, Acka G, Türkan H. One stage transoral odontoidectomy and posterior fixation in odontoid fracture; technical note. Turkish Neurosurgery. 1996;6:111.

Boden SD, Dodge LD, Bohlman HH, Rechtine GR. Rheumatoid arthritis of the cervical spine. A long-term analysis with predictors of paralysis and recovery. J Bone Joint Surg Am. 1993;75(9):1282-97.

Haid RW Jr, Subach BR, McLaughlin MR, Rodts GE Jr, Wahlig JB Jr. C1-C2 transarticular screw fixation for atlantoaxial instability: a 6-year experience. Neurosurgery. 2001;49(1):65-8.

Clark CR, Goetz DD, Menezes AH: Arthrodesis of the cervical spine in rheumatoid arthritis. J Bone Joint Surg Am. 1989;71:381-92.

Xu JJ, Yin QS, Xia H, Wu Z, Ma XY, Zhang K, et al. New clinical classification system for atlantoaxial dislocation. Orthopedics. 2013;36(1):95-100.

Swinkels RA, Oostendop RA. Upper cervical instability: fact or fiction? J Manipulative Physio Ther.1996;19(3):185-94.

Fielding JW, Hawkins RJ. Atlanto-axial rotatory fixation. (Fixed rotatory subluxation of the atlanto-axial joint). J Bone Joint Surg Am. 1977;59(1):37-44.

Reddy AM, Faisal GM, Jyothi SM. A study of indications and assessment of fusion rates for atlantoaxial subluxation. Int Surg J. (2016);3(1):211-6.

Tuite GF, Veres R, Crockard HA, Sell D. Pediatric transoral surgery: indications, complications, and long-term outcome. J Neurosurg. 1996;84(4):573-83.

Dickman CA, Locantro J, Fessler RG. The influence of transoral odontoid resection on stability of the craniovertebral junction. J Neurosurg. 1992;77(4):525-30.

Apfelbaum RI, Lonser RR, Veres R, Casey A. Direct anterior screw fixation for recent and remote odontoid fractures. J Neurosurg. 2000;93(2):227-36.

Eshra MA. C2 Pars/Pedicle screws in management of craniocervical and upper cervical instability. Asian Spine J. 2014;8(2):156-60.

Harms J, Melcher RP. Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976). 2001;26(22):2467-71. 109.

Kalra SK, Jain VK, Jaiswal AK, Behari S. Occipitocervical contoured rod sta: bilization: does it still have a role admist the modern stabilization techniques? Neurol India. 2007;55(4):363-8.

Yeom JS, Buchowski JM, Kim HJ, Chang BS, Lee CK, Riew KD. Risk of vertebral artery injury: comparison between C1-C2 transarticular and C2 pedicle screws. Spine J. 2013;13(7):775-85.

Goel A, Desai K, Mazumdar D. Atlantoaxial fixation using plate and screw method: a report of 160 treated patients. Neurosurg. 2002;51:1351‐6.

Anderson PA, Henley MB, Grady MS, Montesano PX, Winn HR. Posterior cervical arthrodesis with AO reconstruction plates and bone graft. Spine. 1991;16:S72-9.

Jeanneret B, Magerl F, Ward EH, Ward JC. Posterior stabilization of the cervical spine with hook plates. Spine. 1991;16:S56-63.

Nazarian SM, Louis RP. Posterior internal fixation with screw plates in traumatic lesions of the cervical spine. Spine. 1991;16:S64-71.

Levine AM, Mazel C, Roy-Camille R. Management of fracture separations of the articular mass using posterior cervical plating. Spine 1992;17:S447-54.

Fehlings MG, Cooper PR, Errico TJ. Posterior plates in the management of cervical instability: long-term results in 44 patients. J Neurosurg. 1994;81:341-9.

Ebraheim NA, Rupp RE, Savolaine ER, Brown JA. Posterior plating of the cervical spine. J Spinal Disorders. 1995;8:111-5.

Heller JG, Silcox DH III, Sutterlin CE III. Complications of posterior cervical plating. Spine. 1995;20:2442-8.

Wellman BJ, Follett KA, Traynelis VC. Complications of posterior articular mass plate fixation of the subaxial cervical spine in 43 consecutive patients. Spine. 1998;23:193-200.

Horgan MA, Kellogg JX, Chesnut RM. Posterior cervical arthrodesis and stabilization: an early report using a novel lateral mass screw and rod technique. Neurosurgery. 1999;44:1267-71; discussion 71-2.

Ni B, Zhu Z, Zhou F. Bilateral C1 laminar hooks combined with C2 pedicle screws fixation for treatment of C1-C2 instability not suitable for placement of transarticular screws. European Spine J. 2010;19(8):1378-82.

Katonis P, Papadakis SA, Galanakos S. Lateral mass screw complications: analysis of 1662 screws. J Spinal Disorders Tech. 2011;24:415-20.

Liu H, Ploumis A, Schwender JD, Garvey TA. Posterior cervical lateral mass screw fixation and fusion to treat pseudarthrosis of anterior cervical fusion. J Spinal Disorders Tech. 2012;25:138-41.

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Published

2017-03-28

How to Cite

Dasari, R., Prasad, K. S., Sandeep, B., & Raman, B. V. S. (2017). Case series of clinical study and surgical management of atlanto axial dislocation our institute experience. International Journal of Research in Medical Sciences, 5(4), 1230–1240. https://doi.org/10.18203/2320-6012.ijrms20170951

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Original Research Articles