Combined preoperative traction with instrumented posterior occipitocervical fusion for severe ventral brainstem compression secondary to displaced os odontoideum: technical report of 2 cases.

Published

Journal Article

Severe os odontoideum causing ventral brainstem compression is a rare and difficult entity to treat. It is generally accepted that severe os odontoideum causing ventral brainstem compression and neurological deficits warrants surgical treatment. This often requires both anterior and posterior procedures. Anterior approaches to the craniocervical junction are fraught with complications, including infection and risk of injury to neurovascular structures. External traction systems traditionally require long-term bedrest. The authors report 2 cases of severe ventral brainstem compression secondary to displaced os odontoideum and describe their use of extended preoperative halo vest traction to reduce the severe kyphosis and improve neurological function, followed by posterior occipitocervical fusion. Postoperatively both patients showed remarkable improvements in their neurological function and kyphotic deformity. Preoperative halo vest traction combined with posterior occipitocervical fusion appears to be a safe and effective method to treat brainstem compression by severe os odontoideum. It allows for adequate decompression of ventral neural structures and improvement of neurological function, but it is not hindered by the risks of anterior surgical approaches and does not restrict patients to strict bedrest as traditional traction systems. This method of halo vest traction and posterior-only approaches may be transferable to other cervical instability issues with both anterior and posterior pathologies.

Full Text

Duke Authors

Cited Authors

  • Abd-El-Barr, MM; Snyder, BD; Emans, JB; Proctor, MR; Hedequist, D

Published Date

  • December 2016

Published In

Volume / Issue

  • 25 / 6

Start / End Page

  • 724 - 729

PubMed ID

  • 27564788

Pubmed Central ID

  • 27564788

Electronic International Standard Serial Number (EISSN)

  • 1933-0715

Digital Object Identifier (DOI)

  • 10.3171/2016.5.PEDS16122

Language

  • eng

Conference Location

  • United States