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Odontoid process and C1-C2 corrective osteotomy through a posterior approach: technical case report
1Department of Neurosurgery, Frenchay Hospital, Bristol, England.
Neurosurgery
|December 16, 1998
Summary
This study presents a novel posterior surgical approach for accessing the upper cervical spine, including the atlas and axis odontoid process. This technique offers a viable alternative when anterior approaches are challenging, improving surgical options for complex cases.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Surgery
Background:
- Ankylosing spondylitis can lead to severe cervical spine deformity, complicating surgical access to the upper cervical vertebrae.
- Traditional anterior approaches to the atlas (C1) and axis (C2) may be technically challenging or impossible in cases of severe deformity and fusion.
Observation:
- A patient with ankylosing spondylitis and severe cervical spine flexion deformity presented with limited jaw opening and forward gaze.
- Radiological evaluation revealed fusion of C1, C2, and the clivus, with no neurological deficit.
Findings:
- A posterior surgical approach was successfully utilized to access the anterior elements of the atlas and axis, including the odontoid process.
- The technique involved a posterior incision, excision of the C1 posterior arch, mobilization of vertebral arteries, wedge osteotomy of C1 lateral masses and the odontoid, followed by C1-C2 fixation.
Implications:
- This posterior surgical technique provides effective access to the odontoid process, offering a crucial alternative for complex upper cervical spine pathologies.
- It expands the surgical armamentarium for treating conditions like severe cervical kyphosis or ankylosing spondylitis where anterior access is compromised.