Microendoscopic Anterior Approach for Irreducible Atlantoaxial Dislocation: Surgical Techniques and Preliminary Results

J Spinal Disord Tech. 2010 Apr;23(2):113-20. doi: 10.1097/BSD.0b013e3181988bf5.


Study design: Surgical techniques and preliminary results.

Objective: To describe and evaluate the safety and efficacy of a new minimal invasive technique for the irreducible atlantoaxial dislocation (IADD).

Summary of background data: Endoscope has been widely used in minimal invasive spinal surgery. However, there are no clinical reports regarding anterior approach for IADD in the literature.

Methods: Ten consecutive patients with IADD were treated by anterior release with microendoscopic aide and subsequently reduction, anterior transarticular screw fixation and morselized autologous bone grafts. There were 3 cases of odontoid dysplasia, 4, chronic odontoid fracture, 1, odontoid absence, 1 fasilar impression, and 1 malunion of odontoid fracture. According to Symon and Lavender's classification of disability, 6 cases were moderate disability, 3 severe nonbedbound, and 1 severe bedridden. The procedure was performed by the same surgeon (Yong-Long Chi).

Results: The new technique was performed successfully in all cases. All the patients underwent transarticular screw fixation and anterior morselized autograft fusion. The average operation time was 120 min (range, 90 to 150 min) and the mean estimated blood loss was 150 mL (range, 100 to 250 mL). Postoperative radiographs demonstrated that 9 cases restored anatomic position and 1 had partial reduction. According to the postoperative computed tomography all the screws were appropriately placed. Follow-up after surgery, longest is 16 months and minimal 8 months with a mean of 12 months, neurologic status was improved in all patients. There was no loss of fixation and solid fusion was achieved in all cases.

Conclusions: Surgical technique of microendoscopic anterior release, reduction, fixation, and fusion is safe and reliable minimally invasive for treating IADD.

MeSH terms

  • Adult
  • Atlanto-Axial Joint / diagnostic imaging
  • Atlanto-Axial Joint / pathology
  • Atlanto-Axial Joint / surgery*
  • Axis, Cervical Vertebra / diagnostic imaging
  • Axis, Cervical Vertebra / pathology
  • Axis, Cervical Vertebra / surgery
  • Bone Screws
  • Bone Transplantation
  • Cervical Atlas / diagnostic imaging
  • Cervical Atlas / pathology
  • Cervical Atlas / surgery
  • Endoscopy / methods*
  • Female
  • Humans
  • Internal Fixators
  • Joint Dislocations / diagnostic imaging
  • Joint Dislocations / pathology
  • Joint Dislocations / surgery*
  • Joint Instability / diagnostic imaging
  • Joint Instability / pathology
  • Joint Instability / surgery*
  • Male
  • Microsurgery / instrumentation
  • Microsurgery / methods*
  • Middle Aged
  • Minimally Invasive Surgical Procedures / instrumentation
  • Minimally Invasive Surgical Procedures / methods
  • Neurosurgical Procedures / instrumentation
  • Neurosurgical Procedures / methods
  • Odontoid Process / diagnostic imaging
  • Odontoid Process / pathology
  • Odontoid Process / surgery
  • Radiography
  • Retrospective Studies
  • Spinal Fractures / diagnostic imaging
  • Spinal Fractures / pathology
  • Spinal Fractures / surgery
  • Spinal Fusion / instrumentation
  • Spinal Fusion / methods*
  • Treatment Outcome