Atlantoaxial Joint Distraction and Fusion with DTRAX Intra-Articular Cages: A Cadaveric Feasibility Study and Review of the Pertinent Literature

Atlantoaxial joint distraction is a key procedure for the treatment of selected patients affected by basilar invagination (BI). In recent years, several authors have reported various techniques of distraction and fixation of the C1–C2 joint using different types of intra-articular spacers, with or w...

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Bibliographic Details
Published in:World neurosurgery 2022-10, Vol.166, p.153-158
Main Authors: Rapisarda, Alessandro, Pennisi, Giovanni, Montano, Nicola, Della Pepa, Giuseppe Maria, Ricciardi, Luca, De-Giorgio, Fabio, Visocchi, Massimiliano, Olivi, Alessandro, Polli, Filippo Maria
Format: Article
Language:English
Subjects:
Adult
Atlanto-Axial Joint - physiology
Atlanto-Axial Joint - surgery
Basilar invagination
Cadaver
Cervical Vertebrae - surgery
DTRAX
Feasibility cadaveric study
Feasibility Studies
Humans
Intra-articular C1–C2 spacers
Platybasia
Spinal Fusion - methods
Tomography, X-Ray Computed
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Summary:Atlantoaxial joint distraction is a key procedure for the treatment of selected patients affected by basilar invagination (BI). In recent years, several authors have reported various techniques of distraction and fixation of the C1–C2 joint using different types of intra-articular spacers, with or without posterior fixation. We review the pertinent literature and propose a feasibility study on the use of a new device for the distraction of the C1–C2 joint aimed to the descent of the dens out of the foramen magnum suggesting its application on selected cases of BI. The GL-DTRAX Cervical Cage–SE is a cage approved by the Food and Drug Administration for distraction and fixation of subaxial cervical spine. Five adult cadaveric specimens were dissected surgically to evaluate the feasibility of DTRAX insertion inside the C1–C2 joint through a posterior approach. The cages were uneventfully set into the C1–C2 intra-articular space of all samples without the need to sacrifice C2 nerve roots and ganglia. Postoperative cervical computed tomography scanning confirmed the correct fitting of the devices in every sample. This cadaveric study highlights the feasibility of the DTRAX cage as a C1–C2 intra-articular device producing a substantial distraction of atlantoaxial complex and suggesting a possible therapeutic role in selected cases of BI.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2022.07.077