title: Further cranial settling of the upper cervical spine following odontoidectomy. Report of two cases.
abstract: A variety of diseases may affect the craniovertebral junction and require a decompressive and fusion procedure. Craniovertebral junction instability is expected after a fusion procedure. The authors describe two patients with basilar invagination who underwent transoral odontoidectomy and occipitocervical fixation. Despite an uneventful immediate postoperative course, further cranial settling of the C-2 vertebral body (VB) was demonstrated. One patient experienced neurological deterioration and required a second decompressive procedure, whereas the second patient was asymptomatic and required no additional surgery. It was concluded that the odontoidectomy may have led to horizontal separation of the C-1 lateral masses, resulting in further cranial settling of the C-2 VB. Preservation of one aspect of the C-1 anterior arch minimizes C-1 lateral mass offset and, in turn, further cranial settling of the C-2 VB. In addition, a more rigid fixation of C-2 may minimize the possibility of horizontal separation of the C-1 lateral masses after transoral odontoidectomy.
authors.affiliation: Department of Neurosurgery, Dokuz Eylül University Hospital, Izmir, Turkey. snaderi@deu.edu.tr
authors.forename: S
authors.initials: S
authors.lastname: Naderi
authors.forename: M N
authors.initials: MN
authors.lastname: Pamir
mesh_terms: D000328:Adult; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009809:Odontoid Process / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation; D013122:Spinal Diseases / Q000601:surgery