Atlantoaxial Dislocation with Bony Fusion of C1/2 Facet Joints Treated with Posterior Joint Release, Distraction and Reduction

Abstract

Introduction: Atlantoaxial dislocation (AAD) is a complicated and challenging deformity with severe morbidities. Irreducible AAD with C1/2 bony fusion requires anterior (transoral or transnasal) odontoidectomy to decompress spinal cord or medulla, which is highly demanding technique that is risky for comorbidities. Here, we report our application of modified Goel's technique to reduce AAD with bony fusion through single-stage posterior approach surgery. Technical Note: Our technique that can reduce AAD with bony fusion through single-stage posterior approach surgery is reported. Joint release, distraction, cage implantation, and atlantoaxial or occipitocervical fixation can successfully manage AAD with C1/2 bony fusion. Key points for the technique include pinpointing original joint space, thorough release of bony fusion, stepwise distraction, and cage implantation with autograft. Conclusions: Joint release, distraction, cage implantation, and atlantoaxial or occipitocervical fixation can successfully manage bony irreducible AAD. This technique provided an option for bony fused AAD and improved safety and efficacy of its management.

Keywords

• atlantoaxial dislocation
• basilar invagination
• irreducible
• bony fusion
• posterior approach