title: Distraction, compression, and extension reduction of basilar invagination and atlantoaxial dislocation: a novel pilot technique.
abstract: BACKGROUND
  The management of basilar invagination (BI) and atlantoaxial dislocation (AAD) is a challenge.
  
  
  OBJECTIVE
  To describe a new innovative method to reduce BI and AAD through a single-stage posterior approach.
  
  
  METHODS
  Thirty-five patients had irreducible BI and AAD (May 2010 to April 2012). In all patients, reduction of AAD and BI was achieved by using an innovative method of distraction and spacer placement, followed by compression and extension. A C1 lateral mass/C2 translaminar screw was performed in cases where the C1 arch was not assimilated, and occipito-C2 translaminar screw fixation was performed in cases where the C1 arch was assimilated.
  
  
  RESULTS
  Thirty-two of 35 (94%) patients improved clinically and 2 patients had stable symptoms (mean Nurick postoperative score = 1.4; preoperative score = 3.7). AAD reduced completely in 33/35 patients and >50% in 2. BI improved significantly in all patients. Solid bone fusion was demonstrated in 24 patients with at least 1-year follow-up (range, 12-39 months; mean, 19.75 + 7.09 months). The duration of surgery was 80 to 190 minutes, and blood loss was 90 to 500 mL (mean, 170 ± 35 mL). There was 1 death because of cardiac etiology and 1 morbidity (wound infection).
  
  
  CONCLUSIONS
  Distractive compressive extension and reduction of BI and AAD seems to be an effective and safe method of treatment. It is different from the earlier described techniques, because it is the first procedure that uses a spacer not, only for distraction, but also as a pivot to perform extension to reduce the AAD.
authors: Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India. saratpchandra3@gmail.com
authors: P Sarat
authors: PS
authors: Chandra
authors: Amandeep
authors: A
authors: Kumar
authors: Avnish
authors: A
authors: Chauhan
authors: Abuzar
authors: A
authors: Ansari
authors: Nalin K
authors: NK
authors: Mishra
authors: Bhawani S
authors: BS
authors: Sharma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001268:Atlanto-Axial Joint / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D010865:Pilot Projects; D010985:Platybasia / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult