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Vol. 32. Issue 2.
Pages 94-98 (March - April 2021)
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Vol. 32. Issue 2.
Pages 94-98 (March - April 2021)
Case Report
Transcervical approach with endoscopic assistance for surgical treatment of patient with irreducible atlantoaxial dislocation: a case report
Abordaje transcervical con asistencia endoscópica para el tratamiento quirúrgico de pacientes con luxación atloaxoidea irreductible: un informe de caso
Ivan Lvova,
Corresponding author
dr.speleolog@gmail.com

Corresponding author.
, Andrey Grina,b, Ivan Godkova, Ulugbek Khushnazarova, Vladimir Krylova,b
a Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia
b Evdokimov Moscow State University of Medicine and Dentistry , Russia
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Table 1. VAS, NDI, JOA and SF-36 questionnaire scores for presented patient before surgery and 1 year after operation.
Abstract

We demonstrate the case of a surgery in a patient with irreducible atlantoaxial dislocation (IrAAD) after C2 fracture. The challenges of this case were the flexed head in a forced position, impossibility of neck extension, and revision operation after posterior occipito-cervical fixation. The patient underwent the following surgeries: 1. A ventral release of C1-C2 using transcervical endoscopy; 2. Removal of occipito-cervical system and fibrous block resection in the posterior surfaces of the C1-C2; 3. Reducing of AAD and odontoid screw fixation; 4. Posterior C1-C2-C3 screw fixation. Ankylosing of C1-C2 and C2-C3-C4 fusion was verified by computed tomography scan. There was an improvement in patient status as observed by the increase of the SF-36 scale scores.

The use of endoscopic transcervical approach is a good alternative to the transoral approach. Comparative studies of these methods should be performed regarding the choice of an optimal method of decompression in cases of IrAAD.

Keywords:
Endoscopic transcervical approach
Neglected cervical fracture
Late odontoid fracture
Atlantoaxial dislocation
Endoscopic C1-C2 surgery
Resumen

Mostramos el caso de una cirugía de un paciente con luxación atloaxoidea irreductible (LAAIr) después de una fractura en C2. Las dificultades de este caso fueron la flexión de cabeza en posición forzada, la imposibilidad de extensión cervical y la intervención de revisión después de la fijación occipitocervical posterior. El paciente se sometió a las siguientes intervenciones: 1) Liberación ventral de C1-C2 mediante endoscopia transcervical; 2) Extracción del sistema occipitocervical y resección del bloque fibroso en las superficies posteriores de C1-C2; 3) Reducción de la LAA y fijación con tornillo de la odontoides, y 4) Fijación con tornillo de C1-С2-С3 posterior. El anquilosamiento de C1-C2 y la fusión de C2-C3-C4 se verificó mediante tomografía computarizada. Hubo una mejora en el estado del paciente, tal como mostró el aumento de las puntuaciones de la escala SF-36.

El abordaje transcervical endoscópico es una buena alternativa al abordaje transoral. Deberán realizarse estudios comparativos de estos métodos en relación con la elección de un método óptimo de descompresión en casos de LAAIr.

Palabras clave:
Abordaje transcervical endoscópico
Fractura cervical desatendida
Fractura de odontoides tardía
Luxación atloaxoidea
Cirugía endoscópica en C1-C2

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