Mousavi S R, Liaghat A, Shahpari Motlagh M A, Pishjoo M, Tarokh A, farrokhi M. Launching the DCER (Distraction, Compression, Extension, and Reduction) Technique in Basilar Invagination and Atlantoaxial Dislocation: A Preliminary Report of Two Cases in Iran. Iran J Neurosurg 2023; 9 : 2
URL:
http://irjns.org/article-1-341-en.html
1- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran AND Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
2- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
3- Department of Neurosurgery, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
4- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran AND Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran , farokhim@sums.ac.ir
Abstract: (3329 Views)
Background and Importance: Developmental craniovertebral junction (CVJ) anomalies are often comprised of irreducible atlantoaxial dislocation (AAD) and basilar invagination (BI) associated with the fusion of the C1 arch. BI is described as a congenital upward displacement of mostly the odontoid process into the foramen magnum, which AAD can accompany. The DCER (Distraction, Compression, Extension, and Reduction) consists of decompression of craniocervical junction, BI reduction followed by occipitocervical fusion in anatomic lordotic curvature –performing extension and compression. This technique has recently been applied in patients with BI and AAD, demonstrating satisfactory results.
Case Presentation: Herein, we report two cases of BI with AAD who underwent surgery with the DCER technique for the first time in our center.
Conclusion: BI has been managed with combined approach (anterior odontoid resection followed by posterior craniocervical fusion). Since last decade, single posterior approaches has been utilized to reduce and stabilize BI and AAD. DCER approach is the most recent and successful procedure.
Article number: 2
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• Basilar invagination (BI) is associated with instability of the craniovertebral junction, mainly atlantoaxial dislocation (AAD), and causes brainstem and upper cervical spinal cord compression.
• Many approaches have been utilized in the past, targeting mainly anterior and posterior resection, decompression, and circumferential fusion.
• Recently, a single posterior approach has been introduced with better results in decompression and fusion in addition to gaining odontoid reduction instead of resection. This approach is named DCER (distraction, compression, extension, and reduction) due to posterior craniocervical decompression followed by “distraction” of the C1-C2 joint with spacer materials, fixing craniocervical construct with “extension” and “compression” in order to gain anatomic
lordosis, and “reduction” of the odontoid process.
Type of Study:
Case Series |
Subject:
Spine