Mitsumori K, Saito H, Motomiya M, Yada K
No Shinkei Geka. 1975 Jul;3(7):585-91.
The two approaches are well-known in the surgical treatment of atlanto-axial dislocation, the one is the anterior and the other is the posterior approach. The indication of these methods is still controversial. This report concerns with one case of atlanto-axial dislocation with the separate odontoid and bilateral obstruction of both vertebral arteries, which was successfully treated by transoral decompression and fusion between the bodies of the atlas and axis. The reasons why we chose this method were: (1) the spinal cord decompression was necessary because of the presence of compression of the cord by the separate odontoid process, (2) the spinal fusion had to be performed to stabilize the atlanto-axial articulation, (3) it was necessary to avoid the damage of collateral circulations to the brainstem through the deep cervical arteries demonstrated by bilat vertebral angiography. The posterior approach is highly susceptible to injure these collateral circulations.
这两种方法在寰枢椎脱位的外科治疗中广为人知，一种是前路手术，另一种是后路手术。这些方法的适应症仍存在争议。本报告涉及1例齿突分离且双侧椎动脉梗阻的寰枢椎脱位病例，该病例通过经口减压及寰椎与枢椎体间融合术成功治愈。我们选择该方法的原因如下：（1）由于分离的齿突对脊髓造成压迫，故需进行脊髓减压；（2）必须进行脊柱融合以稳定寰枢关节；（3）双侧椎动脉造影显示，有必要避免通过颈深动脉对脑干侧支循环造成损伤。后路手术极易损伤这些侧支循环。
