Abstract
BackgroundThe revision surgery of basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD) after a previous occipitocervical fusion (OCF) is challenging. Transoral revision surgery has more advantages than a combined anterior and posterior approach in addressing this pathology. The C-JAWS is a cervical compressive staple that has been used in the lower cervical spine with many advantages. Up to now, there is no report on the application of C-JAWS in the atlantoaxial joint. We therefore present this report to investigate the clinical outcomes of transoral intraarticular cage distraction and C-JAWS fixation for revision of BI with IAAD.MethodsFrom June 2011 to June 2015, 9 patients with BI and IAAD were revised by this technique after previous posterior OCF in our department. Plain cervical radiographs, computed tomographic scans and magnetic resonance imaging were obtained pre- and postoperatively to assess the degree of atlantoaxial dislocation and compression of the cervical cord. The Japanese Orthopedic Association (JOA) score was used to evaluate the neurological function.ResultsThe revision surgeries were successfully performed in all patients. The average follow-up duration was 18.9 ± 7.3 months (range 9–30 months). The postoperative atlas-dens interval (ADI), cervicomedullary angle (CMA), distance between the top of the odontoid process and the Chamberlain line (CL) and JOA score were significantly improved in all patients (P < 0.05). Bony fusion was achieved after 3–9 months in all cases. No patients developed recurrent atlantoaxial instability.ConclusionsTransoral revision surgery by intraarticular cage distraction and C-JAWS fixation could provide a satisfactory outcome for BI with IAAD after a previous unsuccessful posterior operation.
Highlights
The revision surgery of basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD) after a previous occipitocervical fusion (OCF) is challenging
Once a satisfactory reduction was failed after OCF, a subsequent revision surgery, which is usually requisite for the residual compression of the spinal cord, will be more difficult to perform because the posterior structure of the craniocervical level has been destroyed in previous OCF procedure [5, 6]
It has been reported that CJAWS, a cervical compressive staple, can reduce the postoperative complications linked to the use of plates in anterior cervical discectomy and fusion (ACDF) due to its smaller profile [7, 8]
Summary
The revision surgery of basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD) after a previous occipitocervical fusion (OCF) is challenging. Because of more technical difficulty of anterior approach, in clinical practice, a posterior-only occipitocervical fusion (OCF) procedure is frequently used to address BI with AAD regardless of the reducibility [3, 4]. Once a satisfactory reduction was failed after OCF, a subsequent revision surgery, which is usually requisite for the residual compression of the spinal cord, will be more difficult to perform because the posterior structure of the craniocervical level has been destroyed in previous OCF procedure [5, 6]. It has been reported that CJAWS, a cervical compressive staple, can reduce the postoperative complications linked to the use of plates in anterior cervical discectomy and fusion (ACDF) due to its smaller profile [7, 8]. No reports on the use of C-JAWS for atlantoaxial fixation has been published
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