Vertebral artery mobilization for C1-2 reduction and fixation.

Michael M Mcdowell,David O Okonkwo,Maximiliano Nuñez,Andrew Venteicher,Paul A Gardner,Ezequiel Goldschmidt

doi:10.3171/2020.1.focusvid.19555

Abstract

Craniocervical instability due to chronic atlantoaxial dissociation presents the challenge of providing adequate decompression, reduction, and fixation to promote long-term stability while avoiding iatrogenic vertebral artery dissection or entrapment. The authors present one patient with chronic atlantoaxial dissociation and basilar invagination treated via Goel’s technique and with bilateral vertebral artery mobilization. There was substantial decompression and reduction postoperatively and the patient was discharged with a stable examination. Vertebral artery mobilization at the C1–2 junction can be safely performed via a standard midline suboccipital incision and dissection without vertebral artery injury.The video can be found here: https://youtu.be/VS1Mt1dBLO4.

Highlights

Craniocervical instability due to chronic atlantoaxial dissociation presents the challenge of providing adequate decompression, reduction, and fixation to promote long-term stability while avoiding iatrogenic vertebral artery dissection or entrapment
0:20 This is a case in which bilateral vertebral artery mobilization during operative reduction of basilar invagination was performed using Goel’s technique.[1]
The patient is a 56-year-old woman with rheumatoid arthritis who presented to clinic with upper extremity numbness, shocking neck pain with movement, and progressive upper extremity weakness

Summary

Introduction

Craniocervical instability due to chronic atlantoaxial dissociation presents the challenge of providing adequate decompression, reduction, and fixation to promote long-term stability while avoiding iatrogenic vertebral artery dissection or entrapment. KEYWORDS vertebral artery mobilization; Goel’s technique; atlantoaxial dissociation; video 0:20 This is a case in which bilateral vertebral artery mobilization during operative reduction of basilar invagination was performed using Goel’s technique.[1] A subsequent CTA of the neck demonstrated severe chronic atlantoaxial subluxation with worrisome displacement of the vertebral arteries bilaterally.

Results

Conclusion