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Atlantoaxial Instability

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1. Is Initial Posterior Atlantoaxial Fixation and Fusion Applying Bilateral C1-2 Transarticular Screws and C1 Laminar Hooks Reliable for Acute Pediatric Atlantoaxial Instability? A Minimal Ten-Year Analysis of Outcome and Radiological Evaluation. (PubMed)

Is Initial Posterior Atlantoaxial Fixation and Fusion Applying Bilateral C1-2 Transarticular Screws and C1 Laminar Hooks Reliable for Acute Pediatric Atlantoaxial Instability? A Minimal Ten-Year Analysis of Outcome and Radiological Evaluation. A retrospective case series study with at least 10 years of follow-up data.To validate the reliability of bilateral C1-2 transarticular screws and C1 laminar hooks and a bone autograft for acute pediatric atlantoaxial instability.The reliability (...) of initial posterior atlantoaxial fusion in pediatric patients is still controversial. To date, however, only a few published articles with short-term follow-up data are available to help spinal surgeons understand the effects of posterior atlantoaxial fusion in the skeletally immature spine.Five pediatric patients with acute atlantoaxial instability underwent atlantoaxial fusion using the above technique over a 3-year period. During a minimum 10-year follow-up period, not only outcomes and complications

2019 Spine

2. Postoperative Regression of Retro-odontoid Pseudotumor after Atlantoaxial Posterior Fixation: 11 Years of Experience in Patients with Atlantoaxial Instability. (PubMed)

Postoperative Regression of Retro-odontoid Pseudotumor after Atlantoaxial Posterior Fixation: 11 Years of Experience in Patients with Atlantoaxial Instability. Case series study.The aim was to investigate the incidence of retro-odontoid pseudotumor in patients with atlantoaxial instability (AAI) and evaluate pseudotumor regression after posterior fixation.The incidence of retro-odontoid pseudotumor in atlantoaxial instability patients remains uncertain. Moreover, the regression of retro (...) -occipital assimilation (n = 4), Morquio syndrome (n = 1), and AAI of unknown cause (n = 12). Pseudotumor size regressed in all 38 patients after atlantoaxial posterior fixation. There was a statistically significant decrease in pseudotumor size (the length between the anterior border of the odontoid process to the posterior border of the pseudotumor) from a mean length of 17.7 to 14.9 mm (P < 0.001).The patients had various underlying diseases and the overall incidence of retro-odontoid pseudotumor

2017 Spine

3. Gallie technique versus atlantoaxial screw-rod constructs in the treatment of atlantoaxial sagittal instability: a retrospective study of 49 patients (PubMed)

Gallie technique versus atlantoaxial screw-rod constructs in the treatment of atlantoaxial sagittal instability: a retrospective study of 49 patients The objectives of this study are to investigate the clinical curative effect of Gallie technique and atlantoaxial screw-rod constructs (SRC) on atlantoaxial sagittal instability and determine the indication of Gallie technique.Data of 49 patients with atlantoaxial sagittal instability from February 2008 to May 2015 were analyzed retrospectively (...) the SRC group in blood loss, operation time, radiographic exposure times, and hospital expense. Statistical difference was observed between the two groups.For patients with atlantoaxial instability who has (1) the atlantodental interval (ADI) which is bigger than 5 mm on lateral flexion-extension X-ray, or Anderson-D'Alonzo type II odontoid fracture, (2) no asymmetry between odontoid process and lateral mass on open-mouth anterior-posterior X-ray, and (3) no dislocation of lateral mass joint on the CT

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2017 Journal of orthopaedic surgery and research

4. Preclinical evaluation of a novel anterior non-fusion fixation device for atlantoaxial instability: an in vivo comparison study in a canine model. (PubMed)

Preclinical evaluation of a novel anterior non-fusion fixation device for atlantoaxial instability: an in vivo comparison study in a canine model. The Anterior Atlantoaxial Non-Fusion Fixation System (AANFS) was a novel motion preservation device for atlantoaxial instability to replace traditional fusion techniques. The purpose of this in vivo study was to evaluate the clinical features and biomechanical properties of this new device in a canine model by comparing it with a conventional (...) similar to those of the intact state.This study for the first time provides an animal model for studying non-fusion strategies of upper cervical spine. The AANFS was able to maintain movement function of the atlantoaxial joint and may be an alternative to traditional fusion techniques. These slides can be retrieved under Electronic Supplementary Material.

2019 European Spine Journal

5. Development of a Retro-Odontoid pseudotumor in the absence of atlantoaxial instability or rheumatoid arthritis Post-Laminoplasty: case report. (PubMed)

Development of a Retro-Odontoid pseudotumor in the absence of atlantoaxial instability or rheumatoid arthritis Post-Laminoplasty: case report. A retro-odontoid pseudotumor (ROP) is commonly associated with atlantoaxial instability (AAI) or rheumatoid arthritis (RA). However, we describe a patient with ROP in the absence of AAI or RA. An 81-year-old man who did not have a history of trauma to the head and neck admitted with neck pain, right upper extremity numbness, lower limb weakness

2019 British Journal of Neurosurgery

6. Symptomatic posterior fossa and supratentorial subdural hygromas as a rare complication following transarticular screw fixation with posterior wiring for atlantoaxial instability: A case report. (PubMed)

Symptomatic posterior fossa and supratentorial subdural hygromas as a rare complication following transarticular screw fixation with posterior wiring for atlantoaxial instability: A case report. Atlantoaxial transarticular screw fixation has been an effective and appealing method for inducing fusion of the C1-C2 complex. This technique is usually performed with Gallie fusion. In performing Gallie fusion using sublaminar wiring, a major concern is the risk of dural tear associated with passing (...) sublaminar wires through the epidural space. We present the first report on symptomatic symptomatic subdural hygroma (SDH) due to transarticular screw fixation with posterior wiring.A 50-year-old man had sustained dens fracture 20 years ago and presented with severe neck pain following a recent traffic accident. The images showed atlantoaxial instability due to nonunion of the dens fracture and the patient underwent transarticular screw fixation with posterior sublaminar wiring using Gallie technique

2019 Medicine

7. Retro-odontoid mass without atlantoaxial instability causing cervical myelopathy: a case report of transdural surgical resection (PubMed)

Retro-odontoid mass without atlantoaxial instability causing cervical myelopathy: a case report of transdural surgical resection Retro-odontoid mass rarely occur in patients with noninflammatory retro-odontoid lesions without atlantoaxial instability. We describe a rare case of retro-odontoid mass without atlantoaxial instability operated on by a transdural approach.The patient was an 83-year-old man who presented with a retro-odontoid mass causing symptomatic cervical myelopathy. Preoperative (...) . The patient's symptoms were alleviated, and he has not had a recurrence or cervical instability in the 7 years since his surgery.We successfully used a transdural approach in the present case and have observed no recurrence for 7 years postoperatively. C1 laminectomy is reportedly beneficial, especially for elderly patients, given the risk of other surgical options using an anterior transoral approach or posterior fusion. However, most tumors do not attenuate after C1 laminectomy alone; hence, we think

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2016 Spinal cord series and cases

8. New Posterior Atlantoaxial Restricted Non-Fusion Fixation for Atlantoaxial Instability: A Biomechanical Study. (PubMed)

New Posterior Atlantoaxial Restricted Non-Fusion Fixation for Atlantoaxial Instability: A Biomechanical Study. Loss of axial rotation and lateral bending after atlantoaxial fusion reduces a patient's quality of life. Therefore, effective, nonfusion fixation alternatives are needed for atlantoaxial instability.To evaluate the initial stability and function of posterior atlantoaxial restricted nonfusion fixation (PAARNF), a new protocol, using cadaveric cervical spines compared with the intact (...) group were significantly greater than in the rod group. However, the values of the PAARNF group showed no significant differences compared with those of the intact group.PAARNF restricted atlantoaxial flexion-extension but preserved axial rotation and lateral bending at the atlantoaxial joint in a type II odontoid fracture model. However, it should not be used clinically until further studies have been performed to test the long-term effects of this procedure.

2016 Neurosurgery

9. Minimally Invasive Microscope-Assisted Stand-Alone Transarticular Screw Fixation without Gallie Supplementation in the Management of Mobile Atlantoaxial Instability (PubMed)

Minimally Invasive Microscope-Assisted Stand-Alone Transarticular Screw Fixation without Gallie Supplementation in the Management of Mobile Atlantoaxial Instability Retrospective study.To evaluate the clinico-radiological efficacy of stand-alone minimally invasive transarticular screw (MIS-TAS) fixation without supplemental Gallie fixation in the management of mobile C1-C2 instability.Data evaluating the efficacy and feasibility of MIS-TAS in the literature is scanty.Patients with mobile (...) atlantoaxial instability and >2 years follow-up were included and managed by stand-alone TAS fixation using the Magerl technique and morselized allograft without additional fixation. Patient demographics and intra-operative parameters were noted. Clinical parameters (Visual Analog Scale [VAS] and Oswestry Disability Index [ODI]), neurology (modified Japanese Orthopaedic Association [mJOA]), and radiological factors (anterior atlanto-dens interval and space available for cord) were evaluated pre

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2018 Asian spine journal

10. Feasibility and outcome of stand-alone trans-articular screw fixation in atlantoaxial instability in children less than 8 years of age. (PubMed)

Feasibility and outcome of stand-alone trans-articular screw fixation in atlantoaxial instability in children less than 8 years of age. To study the feasibility and outcome of stand-alone trans-articular screw (TAS) fixation for atlantoaxial instability (AAI) in children less than 8 years of age.This prospective study was conducted between 2009 and 2014. Thirteen children suffering from AAI were operated for a TAS fixation. Feasibility of TAS fixation was assessed on CT scan and a screw

2018 European Spine Journal

11. Atlantooccipital overlapping and its effect on outcomes after ventral fixation in dogs with atlantoaxial instability (PubMed)

Atlantooccipital overlapping and its effect on outcomes after ventral fixation in dogs with atlantoaxial instability We compared clinical outcomes after ventral fixation in dogs with atlantoaxial instability (AAI) on the basis of the presence or absence of atlantooccipital overlapping (AOO). Of 41 dogs diagnosed with AAI and treated ventral fixation, 12 exhibited AOO (AOO group), whereas 29 did not (non-AOO group). The AOO group had significantly higher neurological scores before (P=0.024

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2018 The Journal of Veterinary Medical Science

12. Retroodontoid Pseudotumor Related to Development of Myelopathy Secondary to Atlantoaxial Instability on Os Odontoideum (PubMed)

Retroodontoid Pseudotumor Related to Development of Myelopathy Secondary to Atlantoaxial Instability on Os Odontoideum Retroodontoid pseudotumor (ROP) is a nonneoplasic lesion of unknown etiology, commonly associated with inflammatory conditions, and the term of pannus is usually used. Less frequently, ROP formation can develop with other noninflammatory entities, with atlantoaxial instability as most accepted pathophysiological mechanism for posttraumatic or degenerative ROP. As it can (...) with retroodontoid soft tissue mass secondary to a chronic atlantoaxial instability on os odontoideum, an extremely rare cause of ROP. The patient developed a posttraumatic cervical myelopathy related to the decompensation of this C1-C2 instability responsible for the formation of a compressive ROP. We will overview the retroodontoid pseudotumor and its differential diagnosis.

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2018 Case Reports in Radiology

13. Biomechanical Comparison of C1 Lateral Mass - C2 Short Pedicle Screw - C3 Lateral Mass Screw-Rod Construct Versus Goel-Harms Fixation For Atlantoaxial Instability. (PubMed)

Biomechanical Comparison of C1 Lateral Mass - C2 Short Pedicle Screw - C3 Lateral Mass Screw-Rod Construct Versus Goel-Harms Fixation For Atlantoaxial Instability. A biomechanical in vitro study using human cadaveric spines.The aim of this study was to compare atlantoaxial stability and stiffness of a C1 lateral mass - C2 short pedicle - C3 lateral mass screw-rod construct versus C1 lateral mass - C2 pedicle screw-rod construct.The C1 lateral mass - C2 pedicle screw-rod construct provides (...) , C2SPED-C3LM may be a suitable alternative surgical strategy for atlantoaxial instability that provides superior atlantoaxial fixation.N/A.

2018 Spine

14. Novel unilateral C1 double screw and ipsilateral C2 pedicle screw placement combined with contralateral laminar screw-rod fixation for atlantoaxial instability. (PubMed)

Novel unilateral C1 double screw and ipsilateral C2 pedicle screw placement combined with contralateral laminar screw-rod fixation for atlantoaxial instability. To investigate the anatomical and biomechanical feasibility of the unilateral C1 double screw [pedicle screw (PS) + lateral mass screw (LMS)] and ipsilateral C2 PS combined with contralateral C2 laminar screw (LS)-rod fixation for atlantoaxial instability by comparison with traditional posterior fixation methods.Fifteen sets of complete (...) mass could mostly contain two screws(PS + LMS) with diameters ≤ 3.5 mm. The novel technique of unilateral C1 double screw and ipsilateral C2 PS combined with contralateral C2 LS rod fixation provided better stability than unilateral PS rod fixation and similar as bilateral PS rod fixation. Therefore, it is a feasible salvage method that provides a new insight into atlantoaxial instability. These slides can be retrieved under Electronic Supplementary Material.

2018 European Spine Journal

15. Post-traumatic Spinal Hygroma Causing Cord Compression in Type III Odontoid Fracture With Vertical Atlantoaxial Instability. (PubMed)

Post-traumatic Spinal Hygroma Causing Cord Compression in Type III Odontoid Fracture With Vertical Atlantoaxial Instability. Case report.To report the first case in the literature of a traumatic cervical spine subdural cerebrospinal fluid (CSF) collection (hygroma) under tension causing cord compression. We suggest etiopathogenesis and modality of treatment.Hygromas are subdural cranial CSF collection. A literature review showed no previous published case of post-traumatic spinal hygroma (...) . This was a potential life-threatening sequelae of a high cervical injury that warranted early diagnosis and emergency treatment.We present a case of a young adult who sustained a traumatic vertical atlantoaxial dislocation associated with a type III odontoid fracture. He was initially scored C6 ASIA D. Magnetic resonance imaging (MRI) demonstrated cord contusion at the craniocervical junction and a small fluid collection anterior to the cervical cord. On day 5 after his injury he developed complete paraplegia

2017 Spine

16. Usefulness of titanium mesh cage for posterior C1-C2 fixation in patients with atlantoaxial instability. (PubMed)

Usefulness of titanium mesh cage for posterior C1-C2 fixation in patients with atlantoaxial instability. The aim of this study was to investigate the usefulness of titanium mesh cage as an interlaminar spacer combined with nitinol shape memory loop fixation in patients with atlantoaxial instability.From April 2009 to March 2017, among the patients with atlantoaxial instability, a total of 30 patients were treated by nitinol shape memory loop fixation combined with titanium mesh cage as a spacer (...) instability. This technique can help surgeons in avoiding vertebral artery injury and reducing bleeding and operation time. Therefore, we suggest that titanium mesh cage spacer combined with nitinol shape memory alloy loop can be a good substitute of autograft for C1-C2 fusion in treating atlantoaxial instabilities.

2017 Medicine

17. Rigid Occipitocervical Instrumented Fusion for Atlantoaxial Instability in an 18-month-old Toddler with Brachytelephalangic Chondrodysplasia Punctata: A Case Report. (PubMed)

Rigid Occipitocervical Instrumented Fusion for Atlantoaxial Instability in an 18-month-old Toddler with Brachytelephalangic Chondrodysplasia Punctata: A Case Report. Case report.We report here on an 18-month-old boy with brachytelephalangic chondrodysplasia punctata (BCDP), whose atlantoaxial instability was successfully managed with occipitocervical instrumented fusion (OCF) using screw and rod instrumentations.Recently, there have been a number of reports on BCDP with early onset of cervical (...) of the odontoid process and atlantoaxial instability were present in lateral radiographs. T2-weighted magnetic resonance (MR) images revealed a high signal region in the spinal cord at the C1-2 and C7-T1 levels. Cervical computed tomography (CT) showed that the pedicles and lateral masses in the cervical spine were small and immature, but the laminae were comparatively thick.One week before surgery, the patient was fitted with a Halo-body jacket. We performed plate-rod placement with occipital cortical screws

2017 Spine

18. Biomechanical evaluation of three ventral fixation methods for canine atlantoaxial instability: a cadaveric study (PubMed)

Biomechanical evaluation of three ventral fixation methods for canine atlantoaxial instability: a cadaveric study Vol. 78, No. 12 (2016), The "received date" year in the manuscript was printed incorrectly. Error: Received 25 March 2015 ↓ Correction: Received 25 March 2016 The Journal of Veterinary Medical Science Editorial Office would like to offer our sincere apologies for this mistake.

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2017 The Journal of Veterinary Medical Science

19. A novel method of C1-C2 transarticular screw insertion for symptomatic atlantoaxial instability using a customized guiding block: A case report and a technical note. (PubMed)

A novel method of C1-C2 transarticular screw insertion for symptomatic atlantoaxial instability using a customized guiding block: A case report and a technical note. Atlantoaxial instability treated with the C1-2 transarticular screw fixation is biomechanically more stable; however, the technique demanding and the potential risk of neurovascular injury create difficulties for clinical usage, and there is still lack of clinical experience till now.We reported an adult female patient (...) with symptomatic atlantoaxial instability due to rheumatoid arthritis that was successfully treated with a bilateral C1-C2 transarticular screw fixation using a customized guiding block. We preoperatively determined the trajectories for bilateral C1-C2 transarticular screws on a 3-dimensional reconstruction model from the computed tomography (CT) and self-developed computer software, and designed a rapid prototyping customized guiding block in order to offer a guide for the entry point and insertion angle

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2016 Medicine

20. Robot-Assisted Posterior C1-2 Transarticular Screw Fixation for Atlantoaxial Instability: A Case Report. (PubMed)

Robot-Assisted Posterior C1-2 Transarticular Screw Fixation for Atlantoaxial Instability: A Case Report. Case report.The aim of this study was to assess the feasibility, safety, and accuracy of a new robotic system for performing posterior C1-2 transarticular screw fixation for atlantoaxial instability.C1-2 transarticular fixation is a reliable procedure. However, the procedure is high-risk because of the important structures and frequent anatomical variation around the atlantoaxial region (...) . Navigation improves the accuracy, but it might require repeated adjustments of the trajectories, which is inconvenient. Robot-assisted surgery can make this process easier and has the potential to improve the safety and accuracy.A 43-year-old man with atlantoaxial deformity and instability underwent posterior C1-2 transarticular screw fixation under the guidance of the new robotic system (TiRobot, co-designed by Beijing Jishuitan hospital and TINAVI Medical Technologies Co., Ltd.). We performed a surgery

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2016 Spine

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