Treatment of Basilar Invagination With Klippel-Feil Syndrome: Atlantoaxial Joint Distraction and Fixation With Transoral Atlantoaxial Reduction Plate.

Published on Apr 1, 2016in Neurosurgery4.853
· DOI :10.1227/NEU.0000000000001094
Gejin Wei2
Estimated H-index: 2
(Southern Medical University),
Zhiyun Wang6
Estimated H-index: 6
+ 6 AuthorsHong Xia4
Estimated H-index: 4
(Southern Medical University)
Klippel-Feil syndrome (KFS) is characterized by congenital vertebral fusion of the cervical spine and a wide spectrum of associated anomalies. In patients with KFS with basilar invagination (BI), compression of the brainstem and upper cervical cord results in neurological deficits, and decompression and occipitocervical reconstruction are required. The highly varied anatomy of KFS makes a posterior occipitocervical fixation strategy challenging. For these patients, the transoral atlantoaxial reduction plate (TARP) operation is an optimal option to perform a direct anterior fixation to achieve stabilization.To evaluate the effectiveness of TARP internal fixation for the treatment of BI with KFS.Ten consecutive patients with BI and KFS who underwent TARP reduction and fixation from 2010 to 2012 were reviewed. Clinical assessment and image measurements were performed preoperatively and at the most recent follow-up. Nine patients (9/10) were followed for an average of 31.44 months.Symptoms were alleviated in 9 of 9 patients (100.00%). The odontoid process was ideally corrected with the TARP system. The mean clivus canal angle improved from 124° preoperatively to 152° postoperatively. The average preoperative and postoperative Japanese Orthopedic Association scores were 10.56 (n = 9) and 14.67 (n = 9), respectively, indicating 63.82% improvement. There was bony bridge catenation on the computed tomography scans and no evidence of hardware failure at 6 months.The TARP operation is effective and safe for treating patients with BI with KFS. The midterm clinical results were satisfactory.
#1Hong XiaH-Index: 4
#2Qingshui YinH-Index: 5
Last. JunJie XuH-Index: 6
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Purpose Although direct transoral decompression and one-stage posterior instrumentation can obtain satisfactory cord decompression for the treatment of basilar invagination with atlantoaxial dislocation, surgical injuries run high as combinative anterior-posterior approaches were necessary. Furthermore, the complications will rise notably when involvement of dens and/or clivus in the decompression necessitates relatively complicated surgical techniques. First initiated in 2005, transoral atlanto...
32 CitationsSource
#1Jincheng YangH-Index: 4
#2Xiang-yang MaH-Index: 10
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Purpose To report the surgical techniques and clinical results of one-stage transoral anterior revision surgeries for basilar invagination (BI) with atlantoaxial dislocation (AAD) after posterior decompression.
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#1P. Sarat Chandra (AIIMS: All India Institute of Medical Sciences)H-Index: 22
#2Amandeep KumarH-Index: 9
Last. Bhawani S. SharmaH-Index: 29
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Abstract The management of basilar invagination (BI) and atlantoaxial dislocation (AAD) is a challenge. To describe a new innovative method to reduce BI and AAD through a single-stage posterior approach. Thirty-five patients had irreducible BI and AAD (May 2010 to April 2012). In all patients, reduction of AAD and BI was achieved by using an innovative method of distraction and spacer placement, followed by compression and extension. A C1 lateral mass/C2 translaminar screw was performed in cases...
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#1Shenglin Wang (PKU: Peking University)H-Index: 14
#2Chao Wang (PKU: Peking University)H-Index: 15
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Abstract : Atlas occipitalization and congenital C2-3 fusion often result in atlantoaxial dislocation (AAD) and superior odontoid migration that requires occipitocervical fixation. The widely used technique is posterior occiput-C2 fixation with pedicle screws. However, congenital C2-3 fusion cases tend to have thinner C2 pedicles that are inadequate for normal-sized pedicle screw fixation. With the presence of AAD, the strength of the fixation is further compromised as the C2 pedicle screws (C2P...
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#1Fuzhi AiH-Index: 10
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Last. Xiao-hong MaiH-Index: 7
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Abstract Retrospective report of two surgical cases and review of the literature. To report the clinical application of transoral atlantoaxial reduction plate (TARP) internal fixation with a novel technique of transoral transpedicular or articular mass screw of C2 in the treatment of irreducible atlantoaxial dislocation and basilar invagination with ventral spinal cord compression. Current surgical treatments for IAAD have various disadvantages, such as posterior decompression followed by atlant...
41 CitationsSource
#1Qing-shui YinH-Index: 11
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Cited By10
#1Qiang Tu (Southern Medical University)
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Objective To evaluate the usefulness of a 3D-printed model for transoral atlantoaxial reduction plate (TARP) surgery in the treatment of irreducible atlantoaxial dislocation (IAAD). Methods A retrospective review was conducted of 23 patients (13 men, 10 women; mean age 58.17 ± 5.27 years) with IAAD who underwent TARP from January 2015 to July 2017. Patients were divided into a 3D group (12 patients) and a non-3D group (11 patients). A preoperative simulation process was undertaken for the patien...
#1Jiang Liu (USTC: University of Science and Technology of China)
#2Rui He (USTC: University of Science and Technology of China)
Last. Chao Wang (PKU: Peking University)
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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. 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 complet...
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