A case of severe basilar invagination and AAD, corrected using the technique of DCER-distraction, compression, extension, reduction (with spacer + universal reducer).

P Sarat Chandra,Mohit Agarwal

doi:10.3171/2020.4.focusvid.20138

Abstract

The author has described his own technique of DCER (distraction, compression, extension, and reduction) to reduce and realign the deformity and relieve spinal compression (indicated in congenital anomalies with occipitalized C1 arch). In addition, he developed special C1–2 spacers and a universal reducer. Here, a 30-year-old male with severe BI (20 mm, above the clivus) with AAD underwent the technique of spacer placement (distraction) followed by cable reduction (leading to compression and extension at the occiput–C1–C2 region). Another short example is presented where an 8-year-old boy (severe BI, AAD with posterior fossa dermoid) underwent additional correction—C2 forward translation and excision of the dermoid.The video can be found here: https://youtu.be/XIMpkYjxgRk

Highlights

The author has described his own technique of DCER to reduce and realign the deformity and relieve spinal compression
0:20 We present a case of severe basilar invagination and atlantoaxial dislocation which was treated by relieving the compression, correcting the deformity, and realigning using the technique of distraction, compression, extension, and reduction, abbreviated as DCER
Compressive forces are applied between the O–C1 and C2, as shown by red arrows, and this leads to correction of both residual basilar invagination and atlantoaxial dislocation

Summary

Introduction

The author has described his own technique of DCER (distraction, compression, extension, and reduction) to reduce and realign the deformity and relieve spinal compression (indicated in congenital anomalies with occipitalized C1 arch). 0:20 We present a case of severe basilar invagination and atlantoaxial dislocation which was treated by relieving the compression, correcting the deformity, and realigning using the technique of distraction, compression, extension, and reduction, abbreviated as DCER. Compressive forces are applied between the O–C1 and C2, as shown by red arrows, and this leads to correction of both residual basilar invagination and atlantoaxial dislocation.

Results

Conclusion