Video-assisted anterior transcervical approach for the reduction of irreducible atlantoaxial dislocation.
METHODS
Technique note.


OBJECTIVE
To describe a modified minimally invasive approach for the treatment of irreducible atlantoaxial dislocation (IAAD).


BACKGROUND
Currently, the most frequently used route for the treatment of symptomatic IAAD is transoral-transpharyngeal approach. Although it provides the most direct route to the atlantoaxial joint, potential problems may arise because of traverse oral cavity, such as the potential risks of infection, postoperative disturbances of breathing, and swallowing. The aim of this study was to describe a less-invasive approach for IAAD.


METHODS
Four consecutive patients with IAAD underwent the combined video-assisted atlantoaxial transcervical release (VAAT) procedure and posterior occipital-cervical fusion or C1-C2 screw fixation at Tongji Hospital. Clinical characteristics, images data, operative variables, and follow-up data were recorded.


RESULTS
Four cases presented with signs and symptoms of spinal cord dysfunction caused by IAAD underwent 1-stage anterior release, reduction, and posterior fixation. Three cases received C1-C2 screw fixation, and 1 case with occipitocervical fixation. Postoperative imaging studies showed that complete decompression was achieved in all the cases. No systemic infections, cerebrospinal fluid leaks, or adverse neurologic sequelae were found. None of the patients required prolonged intubation, tracheostomy, or enteral tube feeding. All patients started to oral intake after anesthesia. Neurologic status in 1 case remained at baseline whereas it improved in the others. The mean follow-up period was 9 months (6 approximately 12 months). All cases achieved solid fusion, without implants failure.


CONCLUSIONS
Our initial experience showed that the VAAT procedure for IAAD is a safe supplement and alternative to conventional and transcervical procedures.
Liu
Tie
T
Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
Li
Feng
F
Xiong
Wei
W
Du
Xingli
X
Fang
Zhong
Z
Shang
Hui
H
Chen
Anmin
A
D000293:Adolescent; D000328:Adult; D001268:Atlanto-Axial Joint / Q000601:surgery*; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D006801:Humans; D016268:Internal Fixators; D004204:Joint Dislocations / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009777:Occipital Bone / Q000601:surgery; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods; D015203:Reproducibility of Results; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000295:instrumentation / Q000379:methods*