Single door laminoplasty plus posterior fusion for posterior atlantoaxial dislocation with congenital malformation:A case report and review of literature

BACKGROUND Posterior atlantoaxial dislocation(PAD)is a rare type of upper cervical spine disease.We sought to describe a unreported case of old PAD with os odontoideum(OO)and atlas hypoplasia(AH)and our unique treatment approach consisting of C1 single door laminoplasty with C1-3 posterior fixation and fusion.CASE SUMMARY A 70-year-old male patient who suffered from progressive aggravating numbness and limb weakness for 4 years without trauma,was diagnosed with old PAD with OO and AH.The patient underwent closed reduction and C1 single door laminoplasty with C1-3 posterior fixation and fusion instead of C1 laminectomy with occipitocervical fusion.During the 3-year follow-up,he was able to walk by himself instead of using a wheelchair and with a±25°range of head rotation as well as a±10°range of flexion-extension.Three-year follow-up images showed satisfactory reduction and fusion.CONCLUSION C1 single door laminoplasty with cervical fusion in PAD combined with spinal cord compression could be a suitable and effective surgical option.Compared with laminectomy and occipitocervical fusion,it retains more cervical range of motion,has a smaller incision and provides an adequate bone grafting space for atlantoaxial fusion.

Early reoccurrence of traumatic posterior atlantoaxial dislocation without fracture:A case report

BACKGROUND In general,atlantoaxial dislocation is rare due to the stability of the C1-C2 complex.Traumatic atlantoaxial dislocations are usually anterior and accompanied by odontoid fractures.Posterior atlantoaxial dislocations are rare,and complete posterior dislocation without associated fracture is even more rare.A case of early recurrence of posterior atlantoaxial dislocation without fracture being in therapy of first closed reduction and then open reduction has not been previously reported.CASE SUMMARY A 45-year-old female presented with traumatic posterior atlantoaxial dislocation(TPAD)of C1-C2 without associated fractures,and Frankel Grade B spinal cord function.She was successfully managed by immediate closed reduction under skull traction.Unexpectedly,17 d later,re-dislocation was discovered.On day 28,closed reduction was performed as before but failed.Then,open reduction and posterior internal fixation with autologous iliac bone grafts was performed.By 6 mo after surgery,atlantoaxial joint fusion was achieved,and neurological function had recovered to Frankel Grade E.At 12 mo follow-up,she had lost only 15°of cervical rotation,and atlantoaxial complex instability in joint flexing and extending were no longer observed under fluoroscopy.CONCLUSION Early assessment of transverse ligament is critical for TPAD without fracture avoiding re-dislocation after closed reduction.

Application of transoral atlantoaxial reduction plate Ⅲ in treatment of complicated atlantoaxial dislocation

Objective To evaluate the biomechanical characteristies and the clinical advantage of transoral atlantoaxial reduction plate (TARP) Ⅲ. Methods Design of TARP-Ⅲ was based on TARP-Ⅱ. The screw hole in the axis was moved 1～2mm upwards

Atlantoaxial pedicle screw system for treatment of unstable atlantoaxial dislocation post traction

Objective To explore the technique and clinical outcome of the atlantoaxial pedicle screw system in the treatment of the unstable altantoaxial dislocation post traction.

One stage anterior release and posterior fusion for the treatment of irreducible atlantoaxial dislocation secondary to os odontoideum

Objective To evaluate clinical effect of the ventral release through high anterior cervical retropharyngeal approach and one stage posterior fusion for the treatment ofirreducible atlantoaxial dislocation (IAAD) secondary

Posterior pedicle screw fixation combined with local steroid injections for treating axial eosinophilic granulomas and atlantoaxial dislocation:A case report

BACKGROUND Eosinophilic granuloma(EG)is a proliferative condition that affects the cells of bone tissue.There are no specific clinical signs or imaging manifestations in the early stages of the disease,making it simple to overlook and misdiagnose.Because of the disease's rarity,there is presently no standardized treatment principle.There are few accounts of such occurrences affecting the axis among children.We discovered a case of a child whose EG resulted in atlantoaxial joint dislocation and destruction of the axial bone.CASE SUMMARY After having pharyngeal discomfort for more than six months without a clear explanation,a 6-year-old boy was brought to our hospital.Following a careful evaluation,the pathology indicated a strong likelihood of an axial EG.Ultimately,we decided to treat the boy with posterior pedicle screw fixation and local steroid injections.CONCLUSION EGs of the upper cervical spine are quite uncommon in children,and they are exceedingly easy to overlook or misdiagnose.Posterior pedicle screw fixation and local steroid injections are effective treatments for patients with axial EGs affecting the atlantoaxial junction.

Surgical treatment of a complex craniocervical malformation combined with posterior cranial fossa teratoma:a case report and literature review

Background:Basilar invagination(BI)with atlantoaxial dislocation(AAD)is not uncommon in patients with scoliosis,Klippel-Feil syndrome(KFS),and other bone deformities.Cases with combinations of the abovementioned dislocations and deformities with posterior cranial fossa teratoma are rare in the clinic and difficult to handle.Case presentation:This case presents a 34-year-old woman diagnosed with atlantoaxial dislocation and posterior cranial fossa mass.After two surgeries,the posterior cranial teratoma was completely removed with satisfactory atlantoaxial reduction.The postoperative 1-year follow-up examination showed that the bone graft fusion was successful,without remaining significant dysfunction.Conclusions:The surgical risk of irreducible atlantoaxial dislocation combined with posterior cranial fossa tumor is huge.Thus,it needs to be fully preoperatively evaluated and managed carefully in accordance with sound surgical principles.

Surgical treatment of congenital basilar invagination with different pathological characteristics: Report of 139 cases

Objective: To describe the different pathological characteristics of congenital basilar invaginations and discuss the surgical treatment of such cases. Methods: A total of 139 patients diagnosed with basilar invaginations underwent surgical treatment from 2008 to 2015. Based on Atul Goel's classification and simultaneous consideration of atlantoaxial dislocation or syringomyelia,the cases were subdivided into four groups. Individualized posterior surgical decompression and/or atlantoaxial reset procedures were performed to correct atlantoaxial dislocation,decompress the brain stem,or resolve syringomyelia. The indications and critical points of each procedure were documented. Results: All 139 patients were surgically treated; 27 patients(19.4%) had underwent at least one decompression surgery previously. On an average,there was gratifying clinical improvement based on the Japanese Orthopaedic Association score analysis.One patient exhibited severe post-operative infection,and the fusion instrument was removed. One patient experienced fracture of internal fixation. Two patients exhibited persistent respiratory symptoms at early stages after the surgery. Four patients felt worse at the latest follow-up. There was no surgical mortality. The poor outcome/morbidity in this series was 5.8%(8/139). Conclusion: The different pathological image characteristics of congenital basilar invaginations based on the presence or absence of syringomyelia and/or atlantoaxial dislocation,reflected the pathological features of complicated basilar invaginations more accurately. Based on these features,different posterior decompression and/or reset procedures,combined with occipitocervical fusion and C1-2 fusion,could be tailored to different patients. These individualized surgeries could reduce surgical complications,decrease morbidity and mortality,and further promote positive outcomes.