Wu Aimin, Jin Haiming, Dou Haicheng, Pan Xiangxiang, Sheng Sunren, Huang Chongan, Wang Xiangyang
Division of Spine Surgery, Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Spine Surgery Center, Key Laboratory of Orthopaedics of Zhejiang Province, Wenzhou 325027, China.
Ann Transl Med. 2020 Feb;8(4):129. doi: 10.21037/atm.2020.02.39.
Atlantoaxial dislocation could be caused by odontoid fractures or Os odontoideum. The previous surgical techniques in treatment of atlantoaxial dislocation were based on arch remove decompression or anterior atlantoaxial release and atlantoaxial (occipital-cervical) screw fixation-based reduction and fusion. However, for some clinical situations, all of above techniques cannot be applied. In this study, a patient with atlantoaxial dislocation caused by Os odontoideum treated by posterior occipitocervical fusion 20 years ago and failed. We design a novel anterior decompression through transoral axis slide and rotation osteotomy for salvage of this failed posterior occipitocervical fusion case. The C2 body and odontoid process was ventrally slide and rotation at good position after operation as well as the position of plate and screws, the spinal canal was increased significantly after operation too. We suggest this anterior decompression through transoral "C2 slide and rotation" technique is good choice for salvage of failed posterior occipitocervical fusion and some irreducible atlantoaxial dislocation because of the anterior bony fusion, it could direct decompress the spinal cord anteriorly, avoid the odontoid resection, and is feasible and safe technique.
寰枢椎脱位可由齿状突骨折或齿突游离小骨引起。以往治疗寰枢椎脱位的手术技术主要基于椎弓切除减压或寰枢椎前路松解以及基于寰枢椎（枕颈）螺钉固定的复位融合。然而，对于某些临床情况，上述所有技术均无法应用。在本研究中，一名20年前因齿突游离小骨导致寰枢椎脱位的患者接受了后路枕颈融合术，但手术失败。我们设计了一种新颖的经口枢椎滑动旋转截骨前路减压术，以挽救这例后路枕颈融合术失败的病例。术后C2椎体和齿突在良好位置腹侧滑动和旋转，钢板和螺钉位置良好，术后椎管也明显增宽。我们认为，这种经口“C2滑动旋转”前路减压技术是挽救后路枕颈融合术失败及一些因前方骨融合导致的不可复位寰枢椎脱位的良好选择，它可以直接对脊髓进行前路减压，避免齿突切除，是一种可行且安全的技术。
