Transoral atlantoaxial anterior decompression and fusion

Two patients with atlantoaxial dislocation (one with an accompanying basilar impression) were treated by a combination of transoral anterior decompression and anterior fusion with good results. Transoral odontoidectomy is hazardous and difficult. However, modern high-speed drills increase the safety and diminish the difficulty of the procedure. If the displacement is irreducible and significant, removal of the protruding odontoid process is considered essential for relief of myelopathy. Simultaneous anterior fusion eliminates the necessity of a second operation, i.e., posterior fusion for stabilization of the atlantoaxial region.