Is Anatomic Reduction Better Than Partial Reduction in Patients with Vertical Atlantoaxial Dislocation?
Qing Wang1, Xinjie Wu2, Mingsheng Tan2
1Department of Spine Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
World Neurosurgery
|March 11, 2018
Summary
Vertical overdistraction during occipitocervical fusion for atlantoaxial dislocation may cause lower cranial nerve palsy. Revision surgery for partial reduction led to recovery of cranial nerve deficits.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Cranial Nerve Surgery
Background:
- Vertical atlantoaxial dislocation (AAD) and basilar invagination (BI) are complex spinal conditions.
- Occipitocervical fusion (OCF) is a surgical treatment for AAD and BI.
- Lower cranial nerve (CN) palsies can be a complication of OCF.
Purpose of the Study:
- To describe lower cranial nerve (CN) palsy after OCF for vertical AAD and BI.
- To investigate the causes of CN palsy following OCF.
Main Methods:
- Retrospective case series of 4 patients with vertical AAD and BI.
- Patients underwent OCF with anatomic reduction.
- Postoperative symptoms and outcomes were analyzed.
Main Results:
- Four patients developed neurogenic dysphagia, dysarthria, and bucking postoperatively.
- Revision surgery to achieve partial reduction resulted in remarkable recovery of CN IX, X, and XI deficits.
Conclusions:
- Vertical overdistraction during OCF for AAD may cause brainstem displacement.
- This displacement can lead to traction injury of cranial nerves IX, X, and XI at the jugular foramen.
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