Basilar Invagination and Atlantoaxial Dislocation: Reduction, Deformity Correction and Realignment Using the DCER (Distraction, Compression, Extension, and Reduction) Technique With Customized Instrumentation and Implants
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 occipitali...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Korean Spinal Neurosurgery Society
2019-06-01
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| Series: | Neurospine |
| Subjects: | |
| Online Access: | http://www.e-neurospine.org/upload/pdf/ns-1938194-097.pdf |
| _version_ | 1797332160874545152 |
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| author | P. Sarat Chandra Jitin Bajaj Pankaj Kumar Singh Kanwaljeet Garg Deepak Agarwal |
| author_facet | P. Sarat Chandra Jitin Bajaj Pankaj Kumar Singh Kanwaljeet Garg Deepak Agarwal |
| author_sort | P. Sarat Chandra |
| collection | DOAJ |
| description | 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 (p<at least 0.001). BI, SI, and CI values correlated with type of pseudo-joints (p<0.0001). Side of neck tilt correlated with the type of pseudo-joint (p<0.0001). Cervical hyperlordosis improved significantly (p<0.0001). Conclusion 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. |
| first_indexed | 2024-03-08T07:45:33Z |
| format | Article |
| id | doaj.art-0d69cf337f1649449719df5b8ed52800 |
| institution | Directory Open Access Journal |
| issn | 2586-6583 2586-6591 |
| language | English |
| last_indexed | 2024-03-08T07:45:33Z |
| publishDate | 2019-06-01 |
| publisher | Korean Spinal Neurosurgery Society |
| record_format | Article |
| series | Neurospine |
| spelling | doaj.art-0d69cf337f1649449719df5b8ed528002024-02-02T16:12:10ZengKorean Spinal Neurosurgery SocietyNeurospine2586-65832586-65912019-06-0116223125010.14245/ns.1938194.097875Basilar Invagination and Atlantoaxial Dislocation: Reduction, Deformity Correction and Realignment Using the DCER (Distraction, Compression, Extension, and Reduction) Technique With Customized Instrumentation and ImplantsP. Sarat ChandraJitin Bajaj0Pankaj Kumar Singh1Kanwaljeet Garg2Deepak Agarwal3 Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, IndiaObjective 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 (p<at least 0.001). BI, SI, and CI values correlated with type of pseudo-joints (p<0.0001). Side of neck tilt correlated with the type of pseudo-joint (p<0.0001). Cervical hyperlordosis improved significantly (p<0.0001). Conclusion 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.http://www.e-neurospine.org/upload/pdf/ns-1938194-097.pdfBasilar invaginationAtlantoaxial dislocationVertebral arteryDistractionCompressionExtension |
| spellingShingle | P. Sarat Chandra Jitin Bajaj Pankaj Kumar Singh Kanwaljeet Garg Deepak Agarwal 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 Basilar invagination Atlantoaxial dislocation Vertebral artery Distraction Compression Extension |
| title | Basilar Invagination and Atlantoaxial Dislocation: Reduction, Deformity Correction and Realignment Using the DCER (Distraction, Compression, Extension, and Reduction) Technique With Customized Instrumentation and Implants |
| title_full | Basilar Invagination and Atlantoaxial Dislocation: Reduction, Deformity Correction and Realignment Using the DCER (Distraction, Compression, Extension, and Reduction) Technique With Customized Instrumentation and Implants |
| title_fullStr | Basilar Invagination and Atlantoaxial Dislocation: Reduction, Deformity Correction and Realignment Using the DCER (Distraction, Compression, Extension, and Reduction) Technique With Customized Instrumentation and Implants |
| title_full_unstemmed | Basilar Invagination and Atlantoaxial Dislocation: Reduction, Deformity Correction and Realignment Using the DCER (Distraction, Compression, Extension, and Reduction) Technique With Customized Instrumentation and Implants |
| title_short | Basilar Invagination and Atlantoaxial Dislocation: Reduction, Deformity Correction and Realignment Using the DCER (Distraction, Compression, Extension, and Reduction) Technique With Customized Instrumentation and Implants |
| title_sort | basilar invagination and atlantoaxial dislocation reduction deformity correction and realignment using the dcer distraction compression extension and reduction technique with customized instrumentation and implants |
| topic | Basilar invagination Atlantoaxial dislocation Vertebral artery Distraction Compression Extension |
| url | http://www.e-neurospine.org/upload/pdf/ns-1938194-097.pdf |
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