Expert’s comment concerning Grand Rounds case entitled “Syringomyelia with irreducible atlantoaxial dislocation, basilar invagination and Chiari I malformation” (by Shenglin Wang, Chao Wang, Ming Yan, Haitao Zhou, Liang Jiang)

Excerpt

The authors describe a case of a 27-year-old woman with a 5-year history of progressive quadriparesis caused by gradual decompensation of cranio-vertebral junction (CVJ) anomaly. The bone anomalies—assimilation of atlas, synostosis of C2–3 and most probably also platybasia were complicated by anterior atlanto-axial dislocation (AAD) and basilar invagination (BI) concomitantly with Chiari I malformation and cervical syringomyelia. Due to lack of movement on dynamic flexion-extension films and no evidence of reduction after 10 min of traction under general anesthesia, the AAD was considered irreducible (IAAD) as described by Wang et al. [9]. The authors therefore proceeded with elective tracheostomy and anterior transoral, muscular and ligamentous release without an actual odontoidectomy. The anterior release allowed for appropriate reduction of AAD that was subsequently stabilized through a posterior occipito-cervical fusion (O-C2) during the same operation. The final re-alignment was excellent and persisted during the 2-year follow-up. …