Response to the Expert’s comment of P. Suchomel concerning Grand Rounds case entitled “Syringomyelia with irreducible atlantoaxial dislocation, basilar invagination and Chiari I malformation”, Eur Spine J, Vol 19, no 3, 2010: pp 367–369 (by Shenglin Wang et al.)

Dear Editor,

Having read the Expert’s comment concerning our case report for Grand Rounds, we appreciate the expert’s advice and attention on our topic.

In the last paragraph, the expert concluded “If the deformity can be reduced by a pure anterior release procedure, the remaining odontoid process does not aid in any further stability and only represents an unnecessary risk…” [1]. During the release procedure, a curette was placed at the superior posterior border of the odontoid process and pulled anteriorly and inferiorly. The tip of odontoid could be decorticated by the curette in this procedure. In addition, we removed part of anterior atlas arch (also decorticated). In doing so, the decorticated odontoid has the chance to fuse with the anterior atlas. We consider that the remaining odontoid and the anterior fusion are very important for the stability of the craniocervical junction, because it can provide a strong anterior column support besides the posterior fusion. Based on this point, we consider that the remaining odontoid is not useless and we prefer not to perform the odontoidectomy.

Again we thank the expert for his comment and look forward to participating in the discussion on this issue.