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Modified Goel's Methods for Basilar Impression: A Case Report with Literature.
Shunji Asamoto1, Yasuyuki Fukui1, Makoto Nishiyama1
1Spine and Spinal Cord Center, Mita Hospital, International University of Health and Welfare, Tokyo.
NMC Case Report Journal
|July 1, 2017
Summary
A modified Goel
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Surgery
Background:
- Basilar impression with severe myelopathy and occipital neuralgia presents a complex surgical challenge.
- Accurate diagnosis using MRI and CT scans is crucial for understanding ventral C1-2 (atlas-axis) compression.
- Occipitalization of the atlas and dens of the axis are key anatomical features in this condition.
Observation:
- A 57-year-old female patient presented with severe myelopathy and occipital neuralgia due to basilar impression.
- Ventral C1-2 myelocompression and occipitalization of the atlas were identified via MRI and CT.
- Initial management involved traction with a Halo vest.
Findings:
- A modified Goel's method involving C1-2 facet distraction and fixation was successfully employed.
- A threaded titanium cylindrical cage was utilized for distraction and fixation, offering strong initial stability.
- Postoperative recovery showed gradual symptomatic and neurological improvement, with bone fusion achieved at 3 years.
Implications:
- This modified Goel's technique, using a titanium cage, offers an effective surgical option for basilar impression.
- The method provides adequate C1-2 joint space and robust fixation, leading to positive patient outcomes.
- This approach may be beneficial for managing similar complex atlantoaxial instability cases.
