Abstract
Background: Distraction of the C1–C2 joint and maintenance thereof by introduction of spacers into the articular cavity can successfully and durably reduce basilar invagination (BI). Thus, with the adjunct of instrumented fusion and decompression, BI-induced myelopathy can be efficiently treated with a one-stage posterior approach. This intervention is technically challenging, and in this paper we describe a procedural variation to facilitate the approach.
Methods and Results: Through a description of a case of BI, the main anatomopathological alteration underlying and perpetrating the condition of BI is elucidated. A technique of realignment of BI is then described in which this alteration is specifically targeted and neutralized. The result is a single-stage posterior-only approach with decompression, C1–C2 distraction and introduction of poly(methyl methacrylate) (PMMA) into the joint cavity. Instrumented occipitocervical fusion completes the procedure.
Conclusion: C1–C2 joint distraction is a technically demanding procedure. By providing a modification of the original technique and a detailed description of the crucial steps necessary to successfully and safely carry it out, we hope to make this excellent procedure more approachable.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Goel A. Treatment of basilar invagination by atlantoaxial joint distraction and direct lateral mass fixation. J Neurosurg Spine. 2004;1(3):281–6.
Chamberlain WE. Basilar impression (platybasia): a bizarre developmental anomaly of the occipital bone and upper cervical spine with striking and misleading neurologic manifestations. Yale J Biol Med. 1939;11:487–96.
von Torklus D, Gehle W. The upper cervical spine: regional anatomy, pathology and traumatology. In: A systematic radiological atlas and textbook. New York: Grune & Stratton; 1972. p. 1–98.
Balasingam V, Anderson GJ, Gross ND, Cheng CM, Noguchi A, Dogan A, McMenomey SO, Delashaw JB Jr, Andersen PE. Anatomical analysis of transoral surgical approaches to the clivus. J Neurosurg. 2006;105:301–8.
Choi D, Crockard HA. Evolution of transoral surgery: three decades of change in patients, pathologies, and indications. Neurosurgery. 2013;73:296–304.
Crockard HA, Johnston F. Development of transoral approaches to lesions of the skull base and craniocervical junction. Neurosurg Q. 1993;3(2):61–82.
Dickman CA, Locantro J, Fessler RG. The influence of odontoid resection on stability of the craniovertebral junction. J Neurosurg. 1992;77:525–30.
Di Lorenzo N, Fortuna A, Guidetti B. Craniovertebral junction malformations. Clinicoradiological findings, long-term results and surgical indications in 63 cases. J Neurosurg. 1982;57:603–8.
Di Lorenzo N. Transoral approach to extradural lesions of the lower clivus and upper cervical spine: an experience of 19 cases. Neurosurgery. 1989;24:37–42.
Di Lorenzo N. Craniocervical junction malformation treated by transoral approach. A survey of 25 cases with emphasis on postoperative instability and outcome. Acta Neurochir. 1992;118:112–6.
Goel A. Craniovertebral junction instability: a review of facts about facets. Asian Spine J. 2015;9:636–44.
Cacciola F, Patel V, Boszczyk BM. Novel use of bone cement to aid atlanto-axial distraction in the treatment of basilar invagination: a case report and technical note. Clin Neurol Neurosurg. 2013;115:787–9.
Competing Interests
The authors declare that they have no competing interests.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Ethics declarations
No financial support was received for this work.
Rights and permissions
Copyright information
© 2019 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Cacciola, F., Boszczyk, B., Perrini, P., Gallina, P., Di Lorenzo, N. (2019). Realignment of Basilar Invagination by C1–C2 Joint Distraction: A Modified Approach to a Paradigm Shift. In: Visocchi, M. (eds) New Trends in Craniovertebral Junction Surgery. Acta Neurochirurgica Supplement, vol 125. Springer, Cham. https://doi.org/10.1007/978-3-319-62515-7_39
Download citation
DOI: https://doi.org/10.1007/978-3-319-62515-7_39
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-62514-0
Online ISBN: 978-3-319-62515-7
eBook Packages: MedicineMedicine (R0)