Reduction techniques in the management of atlantoaxial subluxation

Shetty, Arjun and Kumar, Anil and Chacko, Arjun and Guthe, Sachin (2013) Reduction techniques in the management of atlantoaxial subluxation. Indian Journal of Orthopaedics, 47 (4). pp. 333-339.

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Background:The traditional approach to atlantoaxial subluxation which is irreducible after traction is transoral decompression and reduction or odontoid excision and posterior fixation. Transoral approach is associated with comorbidities. However using a posterior approach a combination of atlantoaxial joint space release and a variety of manipulation procedures, optimal or near optimal reduction can be achieved. We analysed our results in this study based on above procedure. Materials and Methods: 66 cases treated over a 5 year period were evaluated retrospectively. Three cases treated by occipito cervical fusion were not included in the study. The remaining 63 cases were classified into three types. All except two cases were subjected to primary posterior C1-C2 joint space dissection and release followed by on table manipulation which was tailored to treat the type of atlantoaxial subluxation. Optimal or near optimal reduction was possible in all cases. An anterior transoral decompression was needed only in two cases where a bony growth (callus) between the C1 anterior arch and the odontoid precluded reduction by posterior manipulation. All cases then underwent posterior fusion and fixation procedures. Patients were neurologically and radiologically evaluated at regular followups to assess fusion and stability for a minimum period of 6 months. Results: Of the 63 cases who underwent posterior manipulation, 49 cases achieved optimum reduction and the remaining 14 cases showed near optimal reduction. Two cases expired in the postoperative period. None of the remaining cases showed neurological worsening after the procedure. Evaluation at 6 months after surgery revealed good stability and fusion in all except three cases. Conclusion: Atlantoaxial joint release and manipulation can be used to achieve reduction in most cases of atlantoaxial subluxation, obivating the need of transoral odontoid excision.

Item Type: Article
Uncontrolled Keywords: Atlantoaxial joint release; atlantoaxial subluxation; cervical spine injuries
Subjects: Medicine > KMC Manipal > Neuro Surgery
Depositing User: KMC Manipal
Date Deposited: 18 Oct 2013 09:17
Last Modified: 18 Oct 2013 09:17

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