Posterior realignment of basilar invagination with facet joint distraction technique*

* Portions of this work were presented as an oral presentation at the 10th Annual Meeting of Asia Scientific Cervical Spine Society, Seoul, Korea, 11 October 2016.

Abstract

Purpose

We describe our experience with management of basilar invagination (BI) with the atlantoaxial dislocation (C1/C2) joint reduction technique, including posterior atlantoaxial internal fixation.

Materials and methods

From 2008 to 2018, eleven patients with atlantoaxial dislocation (AAD) and BI underwent surgical reduction using C1/C2 the joint reduction technique with a fibular graft/peek cage placement followed by C1 lateral mass/C2 pedicle screw fixation. In two cases that we originally planned to perform C1/C2 joint reduction, occiput-C2 pedicle screw fixation was performed instead due to intraoperative challenges. Post-operative course and surgical complications will be discussed.

Results

A total of 13 patients, with an average age of 30.46 ± 13.23 years (range 12–57), were operated. In one patient, iatrogenic vertebral artery injury occurred without any neurological complication. JOA score improved from 10.45 ± 1.128 to 15.0 ± 1.949 (p < 0.0001, paired t-test). All radiological indices were improved (p at least < 0.001). No construct failure was seen in any of the patients with C1-2 facet joint distraction technique during follow-up, and no additional anterior decompression surgery was required.

Conclusions

C1/C2 joint reduction technique with fibular graft/cervical PEEK cage of BI patients together with AAD seems to be an effective and safe surgical method of treatment.

Keywords:

• Atlantoaxial
• basilar invagination
• distraction
• vertebral artery injury

Authors’ contributions

SS and KY performed the study and surgeries. AG contributed to the surgeries. KY contributed image and data interpretation, the writing of the article, and study design. SS contributed to data interpretation and scientific advice. AG contributed to the data interpretation. All authors read and approved the final manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This is a retrospective chart review study which complies with the country’s ethical requirements and law. No other specific requirements were required according to the national law of authors’ country.

Consent for publication

Informed consent for the surgery was obtained from all individual participants included in this retrospective study.

Acknowledgement

The authors thank Arda Yigitkanli, Georgia Tech Biomedical Enginering Student, US for kindly editing the grammar of the manuscript.

Disclosure statement

The authors declare that they have no competing interests. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.