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Navigated Anterior Full-Endoscopic Transcervical Approach Odontoidectomy for Traumatic Posterior Atlantoaxial
Juan Felipe Abaunza-Camacho1,2,3, Sara Gomez-Niebles1,3, Humberto Madrinan-Navia1,2,3
1Center for Research and Training in Neurosurgery (CIEN), Hospital Universitario de la Samaritana, Bogotá , Colombia.
Operative Neurosurgery (Hagerstown, Md.)
|May 21, 2024
Summary
A novel navigated anterior full-endoscopic transcervical approach (nAFETA) offers a minimally invasive solution for posterior atlantoaxial dislocation (PAAD) treatment, avoiding complications of traditional methods and improving patient outcomes.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Minimally Invasive Techniques
Background:
- Complete posterior atlantoaxial dislocation (PAAD) is a rare, severe injury often resulting from trauma.
- Traditional surgical approaches for odontoidectomy carry significant risks and technical challenges.
- Current treatment strategies for PAAD remain debated, with odontoidectomy frequently indicated.
Purpose of the Study:
- To describe a novel navigated anterior full-endoscopic transcervical approach (nAFETA) for treating PAAD.
- To evaluate the efficacy and safety of nAFETA combined with C1-C2 fixation and fusion.
- To present a minimally invasive alternative to traditional surgical methods for PAAD.
Main Methods:
- A two-staged surgical procedure was performed: nAFETA odontoidectomy with C1-C2 anterior transarticular fixation, followed by posterior C1-C2 wired fusion.
- The technique involved a navigated anterior approach for complete reduction and stabilization.
- A case of a 21-year-old male with PAAD and ASIA B spinal cord injury is presented.
Main Results:
- Successful treatment of PAAD using the nAFETA technique.
- Significant neurological improvement from ASIA B to ASIA E at 2-year follow-up.
- A low Oswestry Disability Index score of 10 points was achieved, indicating good functional recovery.
Conclusions:
- Minimally invasive nAFETA is a safe and effective treatment for PAAD.
- This approach successfully avoids the complications associated with transoral and transnasal routes.
- nAFETA facilitates simultaneous anterior transarticular fixation, enhancing spinal stability.