Surgical Treatment of Atlantoaxial Basilar Compression: Wide Transoral Resection of C2 with Posterior Craniovertebral Stabilization

Yu.A. Shulev, V.V. Stepanenko

(Medical Academy of Postgraduate Education, Municipal Multi-Field Hospital N 2, Saint Petersburg)

Progressing myelopathy and neck pain are main manifestations of basilar compression at a craniovertebral level. Extensive anterior decompression, combined with craniovertebral stabilization, should be regarded as the most effective way of surgical correction.

There were 31 cases (1998-2007) with ventral compression at a craniovertebral level, who underwent transoral decompression. Congenital diseases were revealed in 12 patients, aged 17-65 (a mean value of 47.3 years). The rest 19 cases, aged 36-69 (a mean value of 56.7 years), had rheumatic arthritis, being a cause of compression.

Effective anterior decompression was achieved in 11 cases (3 and 8 patients with congenital pathology and rheumatic arthritis respectively) by performing odontoidectomy with posterior fixation of C1-2. Anterior transoral decompression was performed in 20 cases (8 and 12 patients with congenital pathology and rheumatic arthritis respectively). It was done with the help of odontoidectomy and incomplete resection of C2 with posterior craniocervical fixation of C0-C3.

Clinical manifestations, operation, fixation, clinical results and complications were estimated retrospectively. The majority of cases had considerable postoperative improvement of a neurological status. As for cases with congenital diseases, preoperative JOA increased from 8.7±2.3 up to 12.3±2.7 a year after operation. Preoperative NDI changed from 29.2±2.1 to 18.7±2.3 after operation. Preoperative and postoperative EMS were 9.3±2.4 and 15.2±2.5 respectively. One patient developed a severe neurological complication (spinal stroke) on the third day after operation.

Preoperative JOA in cases with rheumatic arthritis improved from 9.3±2.3 up to 13.7±2.5 a year after operation. Preoperative and postoperative NDI were 29.7±2.2 and 19.1±2.7. Preoperative EMS of 10.2±2.7 became equal to 15.7±2.3 after operation. A follow-up of one year revealed no instability.

Extensive transoral decompression with posterior occipitocervical stabilization makes it possible to correct deformities and to eliminate the spinal cord compression. Use of modern systems of posterior craniovertebral fixation permits to achieve wide bone resection, ensuring effective anterior decompression at a craniovertebral level. Thus, wide anterior decompression with odontoidectomy and incomplete resection of C2, combined with posterior craniovertebral stabilization, is regarded to be an effective method of treatment.