• Atul Goel, Arjun Dhar, Abhidha Shah, Survendra Rai, Nilesh Bakale, and Tejas Vaja.
• Department of Neurosurgery, K.E.M., Hospital and Seth G.S. Medical College, Parel, Mumbai, India; Lilavati Hospital and Research Centre, Bandra (E), Mumbai, India. Electronic address: atulgoel62@hotmail.com.
• World Neurosurg. 2019 Jul 1; 127: e856-e863.

ObjectiveTo analyze the probable causes of failed craniovertebral junction stabilization procedures, and to evaluate the advantages of the Goel technique in revision surgery and the positive factors that lead to reduction of the instability and achieve ultimate arthrodesis.MethodsDuring the period from January 2010 to June 2018, we treated 30 cases where previous attempt at craniovertebral stabilization with various fixation techniques had failed and the patients presented with progressively worsening neurologic deficits. All patients were re-operated by lateral mass fixation techniques described by the senior author. The technique involved opening of the atlantoaxial joint, denuding the articular cartilage, introduction of bone graft within the articular cavity, and plate and screw fixation. No bone decompression was done.ResultsFixation of multiple subaxial spinal segments (n = 9), inclusion of occipital bone in the fixation construct (n = 21), and dependence on metal stabilization rather than bone fusion (n = 19) appear to be important causes of implant failure. All patients improved in clinical symptoms after revision surgery. Postoperative images of all patients demonstrated significant reduction of the atlantoaxial dislocation and craniovertebral junction realignment. During the average follow-up period of 32 months, all reoperated patients continued to show clinical recovery. No further surgery was necessary.ConclusionsAlthough relatively difficult, when indicated, reoperation and direct stabilization of the atlantoaxial joint can result in significant and enduring clinical recovery.Copyright © 2019 Elsevier Inc. All rights reserved.

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