Is anatomical reduction better than partial reduction in patients with vertical atlantoaxial dislocation?

Is anatomical reduction better than partial reduction in patients with vertical atlantoaxial dislocation?

World Neurosurg. 2018 Mar 07;:

Authors: Wang Q, Wu X, Tan M, Wang G, Xu S, Qi Y

Abstract
OBJECTIVE: To describe lower cranial nerve palsy (LCNP) following vertical over-distraction when performing occipitocervical fusion (OCF) to treat vertical atlantoaxial dislocation (AAD) and basilar invagination (BI) and to investigate its possible causes.
METHODS: We report 4 cases with vertical AAD and BI who postoperatively presented with neurogenic dysphagia, dysarthria, and bucking after undergoing anatomical reduction.
RESULTS: Patients underwent revision surgery to achieve partial reduction and demonstrated remarkable recovery of 9th, 10th and 11th nerve deficits.
CONCLUSION: Performing OCF in the over-distraction position to treat vertical AAD may caudally displace the brainstem relative to the cranial base, resulting in traction injury to the 9th, 10th and 11th nerves where they exit the skull base through the jugular foramen.

PMID: 29524722 [PubMed - as supplied by publisher]

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