Abstract
In 1994, the use of interfacet spacer placement was for joint distraction, reduction, and fusion to supplement atlantoaxial or occipitocervical fixation. Here, we present a unique case of bilateral atlantoaxial interfacet fixation using cervical facet cages (CFC) in a pediatric patient with basilar invagination. In addition, we review the literature on atlantoaxial facet fixation. We present a 12-year-old boy with Wiedemann-Steiner syndrome who presented with multiple episodes of sudden neck jerking, described as in response to a sensation of being shocked, and guarding against neck motion, found to have basilar invagination with cervicomedullary compression. He underwent an occiput to C3 fusion with C1-C2 CFC fixation. We also conducted a literature review identifying all publications using the following keywords: “C1” AND “C2” OR “atlantoaxial” AND “facet spacer” OR “DTRAX.” The patient demonstrated postoperative radiographic reduction of his basilar invagination from 6.4 to 4.1 mm of superior displacement above the McRae line. There was a 4.5 mm decrease in the atlantodental interval secondary to decreased dens retroflexion. His postoperative course was complicated by worsening of his existing dysphagia but was otherwise unremarkable. His neck symptoms completely resolved. We illustrate the safe use of CFC for atlantoaxial facet distraction, reduction, and instrumented fixation in a pediatric patient with basilar invagination. Review of the literature demonstrates that numerous materials can be safely placed as a C1-C2 interfacet spacer including bone grafts, titanium spacers, and anterior cervical discectomy and fusion cages. We argue that CFC may be included in this arsenal even in pediatric patients.
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The patient data that support the findings of this study are not publicly available due to patient privacy but are available from corresponding author, MM.
References
Goel A, Laheri V (1994) Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir (Wien) 129(1–2):47–53
Goel A (2004) Treatment of basilar invagination by atlantoaxial joint distraction and direct lateral mass fixation. J Neurosurg Spine 1(3):281–286
Goel A, Sharma P (2005) Craniovertebral junction realignment for the treatment of basilar invagination with syringomyelia: preliminary report of 12 cases. Neurol Med Chir (Tokyo) 45(10):512–7; discussion 518
Goel A (2005) Progressive basilar invagination after transoral odontoidectomy: treatment by atlantoaxial facet distraction and craniovertebral realignment. Spine (Phila Pa 1976) 30(18):E551–5
Goel A, Shah A (2008) Atlantoaxial joint distraction as a treatment for basilar invagination: a report of an experience with 11 cases. Neurol India 56(2):144–150
Yamagata T, Nishijima S, Kou S, Naito K, Nagm A, Ishibashi K, Ohata K, Takami T (2020) Posterior direct reduction of lateral atlantoaxial joints for rigid pediatric atlantoaxial subluxation: a fulcrum lever technique, Spine (Phila Pa 1976) 45(17):E1119-E1126
Lee JY, Im SB, Jeong JH (2017) Use of a C1-C2 facet spacer to treat atlantoaxial instability and basilar invagination associated with rheumatoid arthritis. World Neurosurg 98;874 e13–874 e16
Tominaga H, MacDowall A, Olerud C (2019) Surgical treatment of the severely damaged atlantoaxial joint with C1-C2 facet spacers: three case reports. Medicine (Baltimore) 98(22):e15827
Sommer F, Kirnaz S, Goldberg J, McGrath L Jr, Navarro-Ramirez R, Gadjradj P, Medary B, Hartl R (2022) Treatment of odontoid fractures in elderly patients using C1/C2 instrumented fusion supplemented with bilateral atlantoaxial joint spacers: a case series. Int J Spine Surg 16(3):442–449
Sommer F, Kirnaz S, Goldberg JL, McGrath LB, Schmidt F, Gadjradj P, Medary B, Hartl R (2022) Safety and feasibility of DTRAX cervical cages in the atlantoaxial joint for C1/2 stabilization. Oper Neurosurg (Hagerstown) 22(5):322–327
Siemionow K, Janusz P, Glowka P (2016) Cervical cages placed bilaterally in the facet joints from a posterior approach significantly increase foraminal area. Eur Spine J 25(7):2279–2285
Siemionow K, Janusz P, Phillips FM, Youssef JA, Isaacs R, Tyrakowski M, McCormack B (2016) Clinical and radiographic results of indirect decompression and posterior cervical fusion for single-level cervical radiculopathy using an expandable implant with 2-year follow-up. J Neurol Surg A Cent Eur Neurosurg 77(6):482–488
Goel A, Kulkarni AG, Sharma P (2005) Reduction of fixed atlantoaxial dislocation in 24 cases: technical note. J Neurosurg Spine 2(4):505–509
Kim IS, Hong JT, Sung JH, Byun JH (2011) Vertical reduction using atlantoaxial facet spacer in basilar invagination with atlantoaxial instability. J Korean Neurosurg Soc 50(6):528–531
Srivastava AK, Behari S, Sardhara J, Das KK (2017) Simultaneous odontoid excision with bilateral posterior C1–2 distraction and stabilization utilizing bilateral posterolateral corridors and a single posterior midline incision. Neurol India 65(5):1068–1075
Turel MK, Kerolus MG, Traynelis VC (2017) Machined cervical interfacet allograft spacers for the management of atlantoaxial instability. J Craniovertebr Junction Spine 8(4):332–337
Kiran NA, Kumar VA, Sivaraju L, Kumar VA, Reddy CR, Agrawal A (2018) Management issues in a case of congenital craniovertebral junction anomaly with aberrant retropharyngeal midline course of bilateral cervical internal carotid arteries at C1-C2. World Neurosurg 114:94–98
Xu R, Xia Y, Passias PG, Protopsaltis T, Sciubba DM (2019) Occipitocervical osteotomies and interfacet grafts for reduction of occipitocervical kyphosis and basilar invagination. World Neurosurg 127:391–396
Jain AK, Tawari M, Rathore L, Sahana D, Mishra H, Kumar S, Sahu RK (2022) An experience with Goel-Harms C1–C2 fixation for type II odontoid fractures. J Craniovertebr Junction Spine 13(2):175–181
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The University of Pittsburgh Institutional Review Board (IRB) approved the study “Analyses of Neurosurgery Operative Procedures” on July 27, 2020, under the reference number STUDY20050395. Written informed consent was obtained from the patient’s parent for publication of the details of their medical case and any accompanying images.
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Anand, S.K., Shanahan, R.M., Alattar, A.A. et al. Atlantoaxial facet fixation using cervical facet cage: technical case report and review of the literature. Childs Nerv Syst (2024). https://doi.org/10.1007/s00381-024-06339-2
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DOI: https://doi.org/10.1007/s00381-024-06339-2