To describe a novel transforaminal approach for surgical excision of the atlantoaxial (AA) band and examine its feasibility, safety, and mechanical advantages in an ex vivo study and clinical cases.
26 canine cadavers and 2 canine patients with AA bands.
The transforaminal approach via the first intervertebral foramen was designed to avoid damaging the dorsal AA ligament (DAAL) and dorsal laminas to maintain joint stability. The cadaveric study started on December 2020 and lasted 3 months. The ligamentum flavum (LF) was removed using a novel approach; then, gross examination was conducted to verify the potential damage to the spinal cord and associated structures and the adequacy of LF removal. Subsequently, the ex vivo tension test of the DAAL was conducted to establish whether the approach induced mechanical damage to the ligaments. Finally, 2 dogs diagnosed with an AA band were surgically treated with the transforaminal approach.
In the cadaveric study, postsurgical evaluation verified the subtotal removal of LF without damage to the dura mater. There were no significant differences in the mechanical properties of the DAAL, including the ultimate strength (P = .645) and displacement (P = .855), between the surgical and intact groups during the ex vivo tension test. In clinical cases, clinical signs and neurologic grades improved until the final follow-up.
The described surgical procedure using a transforaminal approach appears to sufficiently permit the removal of an AA band while reducing damage to the DAAL and spinal cord. Our study highlights the feasibility of the transforaminal approach.