Atlantoaxial joint distraction as a treatment for basilar invagination: a report of an experience with 11 cases.
OBJECTIVE
A novel method of treatment of basilar invagination that involves distraction of the atlantoaxial joint using specially designed spiked spacers is described. Bone graft that is additionally placed within the appropriately prepared atlantoaxial joint and posterior to the arch of atlas and lamina of C2 provides bony fusion.


METHODS
Between December 2002 and April 2007, 11 patients underwent the discussed method of fixation at the Department of Neurosurgery, King Edward Memorial Hospital in Mumbai, India. All 11 patients had "congenital" basilar invagination and the symptoms were progressive in nature.


RESULTS
The mean follow-up period was 21 months (range 8-40 months). Neurological improvement and successful distraction with atlantoaxial stabilization and ultimate bone fusion was achieved in all the patients and was documented with dynamic radiography. There were no neurological, vascular, or infective complications.


CONCLUSIONS
We conclude that the described method of atlantoaxial joint distraction and fixation provides an alternative treatment strategy for cases with basilar invagination. "Joint distraction" as a stand-alone method could provide reduction of basilar invagination and firm stabilization in such cases.
Goel
Atul
A
Department of Neurosurgery, King Edward 7th Memorial Hospital and Seth GS Medical College, Parel, Mumbai, Maharashtra, India. atulgoel62@hotmail.com
Shah
Abhidha
A
D000293:Adolescent; D000328:Adult; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D001863:Bone Screws; D002648:Child; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D010985:Platybasia / Q000150:complications / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult