Skip to main content

Main menu

  • Home
  • Content
    • Current Issue
    • Advance Online Publication
    • Archive
  • About Us
    • About ISASS
    • About the Journal
    • Author Instructions
    • Editorial Board
    • Reviewer Guidelines & Publication Criteria
  • More
    • Advertise
    • Subscribe
    • Alerts
    • Feedback
  • Join Us
  • Reprints & Permissions
  • Sponsored Content
  • Other Publications
    • ijss

User menu

  • My alerts

Search

  • Advanced search
International Journal of Spine Surgery
  • My alerts
International Journal of Spine Surgery

Advanced Search

  • Home
  • Content
    • Current Issue
    • Advance Online Publication
    • Archive
  • About Us
    • About ISASS
    • About the Journal
    • Author Instructions
    • Editorial Board
    • Reviewer Guidelines & Publication Criteria
  • More
    • Advertise
    • Subscribe
    • Alerts
    • Feedback
  • Join Us
  • Reprints & Permissions
  • Sponsored Content
  • Follow ijss on Twitter
  • Visit ijss on Facebook
Research ArticleCervical Spine

Is Transoral Surgery Still a Relevant Procedure in Atlantoaxial Instability?

Ramachandran Govindasamy, Veeramani Preethish-Kumar, Swaroop Gopal and Satish Rudrappa
International Journal of Spine Surgery October 2020, 7096; DOI: https://doi.org/10.14444/7096
Ramachandran Govindasamy
1Institute of Neurosciences, Sakra World Hospital, Bellandur, Bangalore, India
2Department of Spine Surgery, Sakra World Hospital, Bellandur, Bangalore, India
MBBS, MS
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Veeramani Preethish-Kumar
1Institute of Neurosciences, Sakra World Hospital, Bellandur, Bangalore, India
MBBS, MRCP (UK), PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Swaroop Gopal
1Institute of Neurosciences, Sakra World Hospital, Bellandur, Bangalore, India
MBBS, MCh
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Satish Rudrappa
1Institute of Neurosciences, Sakra World Hospital, Bellandur, Bangalore, India
MBBS, MCh
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
  • PDF
Loading

ABSTRACT

Background The treatment of atlantoaxial instability (AAI) involves stable fixation and fusion with adequate decompression of spinal cord. After the advent of the Goel posterior joint manipulation technique, most of the once irreducible atlantoaxial dislocations (AAD) could be reduced and the need for transoral odontoidectomy became almost nil. Here we tried to iterate the indications of anterior transoral odontoid surgery for AAI in the current scenario.

Methods A retrospective study compiling the clinical, radiological, and surgical characteristics of 6 cases (5 scenarios). These patients underwent anterior transoral surgery alone or in combination with a posterior approach.

Results Two patients had a well-formed occipito-cervical fusion mass, with a displaced odontoid and unreduced C1-C2 joint causing cervical myelopathy. A middle-aged woman presented with unreduced AAD following failed C1-C2 joint distraction technique. A displaced dystopic os odontoideum ossicle was found in an adolescent boy, prohibiting the reduction of AAD. A young man had displacement of the fractured odontoid segment with intact transverse alar ligament and C1-C2 joint complex. One patient had a rare scenario of abnormal orientation of the C1-C2 joint. All 6 patients were successfully treated with adequate spinal cord decompression achieved by the anterior transoral route and stabilization by either the anterior approach itself or in combination with posterior surgery. All had significantly better postoperative outcomes except for 1 patient who expired due to poor respiratory reserve.

Conclusion We tried to emphasize the indications for using transoral anterior odontoid surgery over the posterior approach in the management of AAI. This will prevent the surgical technique of anterior odontoidectomy from becoming an obsolete procedure in the current practice.

  • atlantoaxial instability
  • AAD
  • transoral surgery
  • odontoidectomy

Footnotes

  • Disclosures and COI: The authors have received no funding for this study and report no conflicts of interest.

  • This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2020 ISASS.
Next
Back to top

In this issue

International Journal of Spine Surgery: 19 (S2)
International Journal of Spine Surgery
Vol. 19, Issue S2
1 Apr 2025
  • Table of Contents
  • Index by author

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on International Journal of Spine Surgery.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Is Transoral Surgery Still a Relevant Procedure in Atlantoaxial Instability?
(Your Name) has sent you a message from International Journal of Spine Surgery
(Your Name) thought you would like to see the International Journal of Spine Surgery web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Is Transoral Surgery Still a Relevant Procedure in Atlantoaxial Instability?
Ramachandran Govindasamy, Veeramani Preethish-Kumar, Swaroop Gopal, Satish Rudrappa
International Journal of Spine Surgery Oct 2020, 7096; DOI: 10.14444/7096

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Is Transoral Surgery Still a Relevant Procedure in Atlantoaxial Instability?
Ramachandran Govindasamy, Veeramani Preethish-Kumar, Swaroop Gopal, Satish Rudrappa
International Journal of Spine Surgery Oct 2020, 7096; DOI: 10.14444/7096
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Innovation and Adversity in Spine Surgery: A Retrospective
  • Cervical Myelopathy Secondary to Bilateral Atlantoaxial Pseudoarticulations in Rheumatoid Arthritis: A Case Report
  • Incidence of Traumatic Spinal Injury Following Public Policy Update on Moped Usage in South Carolina
Show more Cervical Spine

Similar Articles

Keywords

  • atlantoaxial instability
  • AAD
  • transoral surgery
  • odontoidectomy

Content

  • Current Issue
  • Latest Content
  • Archive

More Information

  • About IJSS
  • About ISASS
  • Privacy Policy

More

  • Subscribe
  • Alerts
  • Feedback

Other Services

  • Author Instructions
  • Join ISASS
  • Reprints & Permissions

© 2025 International Journal of Spine Surgery

International Journal of Spine Surgery Online ISSN: 2211-4599

Powered by HighWire