Endoscopic Transcervical Approach for Single-stage Anterior Decompression and Stabilization for Atlantoaxial Dislocation

Abstract

Background: Anterior and posterior approaches are used for the management of atlantoaxial dislocation (AAD). Anterior decompression is required in some patients in whom the C1–2 dislocation is not properly reduced by the posterior approach. It can be done using transnasal, transoral, or transcervical approaches. The endoscopic transcervical approach can be used for single-stage decompression and stabilization that includes an odontoidectomy and anterior fusion. Objective: To determine the surgical outcomes of endoscopic transcervical approach for single-stage decompression and fixation for atlantoaxial dislocation. Material and Methods: This was a prospective observational study done at a tertiary center specialized for endoscopic neurosurgery during the period from 2015 to 2021. All surgeries were performed under endoscopic control. Data were collected for the extent of decompression, amount of blood loss, operative time, need for conversion to microscopy, and complications. Results: The age ranged from 5 to 68 years, and follow-up from 12 to 84 months (average = 46 months). Preoperatively, 54 patients were in the Ranawat Grade 3b, 43 in the Ranawat Grade 3a, and 5 in Grade 2. A total of 42 patients needed odontoidectomy with median C2 corpectomy. Conversion to a microscopic approach was not required in any case. Of 102 patients, 90 improved to Ranawat Grade 1, 7 patients to Grade 2, and 5 patients to Grade 3a. The blood loss was between 25 and 100 ml (average = 68 ml). Two patients suffered from screw pull-out. One patient had re-dislocation and was managed with redo surgery. There was no mortality. Conclusion: Endoscopic transcervical single-stage decompression and stabilization is a safe and effective technique for AAD.