Basilar Invagination and Atlantoaxial Dislocation: Reduction, Deformity Correction and Realignment Using the DCER (Distraction, Compression, Extension, and Reduction) Technique With Customized Instrumentation and Implants.
Neurospine
; 16(2): 231-250, 2019 Jun.
Article
em En
| MEDLINE
| ID: mdl-31261462
ABSTRACT
OBJECTIVE:
The technique of distraction, compression, extension, and reduction (DCER) is effective to reduce, realign, and relieve cranio-spinal compression through posterior only approach.METHODS:
Study included all patients with atlantoaxial dislocation and basilar invagination (BI) with occipitalized C1 arch. Study techniques included Nurick grading, computed tomography scan to study atlanto-dental interval, BI, hyper-lordosis, and neck tilt. Sagittal inclination (SI), coronal inclination (CI), cranio-cervical tilt, presence of pseudo-joints, and anomalous vertebral artery were also noted. Patients underwent DCER with/without joint remodeling or extra-articular distraction (EAD) based on the SI being <100°, 100°-160°, or >160° respectively. In cases with pseudo-joints, joint remodeling was performed in type I and EAD in type II. Customized 'bullet shaped' PSC spacers (n=124) and prototype of the universal craniovertebral junction reducer (UCVJR, n=36) were useful.RESULTS:
A total of 148 patients with average age 27.25±17.43 years, ranging from 3 to 71 years (87 males) were operated. Nurick's grading improved from 3.14±1.872 to 1.22±1.17 (p<0.0001). Fifty-two percent of total joints (n=154/296 joints) were either type I (19%)/type II (33%) pseudo-j oints. All traditional indices such as Chamberlein line, McRae line, atlanto-dental interval, and Ranawat line improved (pCONCLUSION:
Occipito-C2 pseudo-joints are important in determining the severity of BI. Asymmetrical pseudo-joint causes coronal/neck tilt. Type of pseudo-joint can strategize by DCER. Customized instruments and implants make technique safe, effective and easier.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Idioma:
En
Revista:
Neurospine
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Índia