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Wu J, Li Y, Chu W, Chen F, Xu Z, Ding Y, Ni B, Lu X, Guo Q. Posterior Release, Reduction, and Intra-Articular Fusion for Irreducible Type III Atlantoaxial Rotary Fixation. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01310. [PMID: 39207149 DOI: 10.1227/ons.0000000000001347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 07/23/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND AND OBJECTIVES For irreducible atlantoaxial rotary fixation (AARF), anterior or posterior release was often needed before posterior reduction and fusion. Anterior atlantoaxial joint release has potential complications such as retropharyngeal abscess, persistent hoarseness, and infection. This study aims to assess the efficacy of posterior release, reduction, and intra-articular fusion without resecting the C2 nerve root on irreducible type III AARF. METHODS The data of 9 pediatric patients diagnosed with AARF who underwent posterior atlantoaxial release, reduction, and intra-articular fusion without resecting the C2 nerve root were retrospectively reviewed. Japanese Orthopaedic Association scores and Visual Analog Scale for Neck Pain were used to assess outcomes. The preoperative and follow-up assessments of atlantodens interval (ADI) were documented to evaluate the reduction of atlantoaxial joint. The patient demographics, surgery time, blood loss, bone fusion time, follow-up period, and surgery-related complications were meticulously documented. RESULTS The mean follow-up duration was 35.1 ± 11.5 months. Complete reduction was achieved in 8 patients, while one patient did not achieve complete reduction. The ADI decreased significantly from 8.7 ± 2.2 mm before surgery to 2.1 ± 1.3 mm at the final follow-up. All patients demonstrated successful bone fusion, with an average fusion period of 3.7 ± 1.3 months. The Visual Analog Scale for Neck Pain at the final follow-up exhibited a significant decrease compared with preoperative values (P < .05), while no significant difference was observed in Japanese Orthopaedic Association scores. There were no complications related to surgery. CONCLUSION Posterior atlantoaxial release, reduction, and intra-articular fusion with a C2 nerve root preservation technique is effective in the treatment of irreducible type III AARF.
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Affiliation(s)
- Ji Wu
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
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Zhang B, Du Y, Zhang C, Qi M, Meng H, Jin T, Cui G, Guan J, Duan W, Chen Z. Analysis of Failed Atlantoaxial Reduction: Causes of Failure and Strategies for Revision. Orthop Surg 2024. [PMID: 39187976 DOI: 10.1111/os.14197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/24/2024] [Accepted: 07/24/2024] [Indexed: 08/28/2024] Open
Abstract
OBJECTIVE The craniovertebral junction (CVJ) presents intricate anatomical challenges. In severe or irreducible malformations, complications such as reduction loss and fixation failure may occur, necessitating revision surgery. The posterior facet joint distraction and fusion (PFDF) technique, offers a solely posterior approach for revisions. Hence, we delineate varied revision scenarios, proposing surgical strategies and technical details to enhance outcomes and mitigate risks, thereby enriching the neurosurgical community's repertoire. METHODS This was a retrospective cohort study, analyzed patient data from Xuanwu Hospital, between 2017 to 2023. All patients had a history of surgical treatment for CVJ malformations, and experienced failure or loss of reduction. The distance from the odontoid process tip to the Chamberlain's line (DCL), the atlantodental interval (ADI), clivus-canal angle, cervicomedullary angle, width of subarachnoid space, CVJ area, and width of syrinx were used for radiographic assessment. Japanese Orthopaedic Association (JOA) scores and SF-12 scores were used for clinical assessment. Independent sample t-tests were employed. A significance level of p < 0.05 indicates statistically significant differences. RESULTS We analyzed data from 35 patients. For patients who underwent PFDF, the postoperative DCL, ADI, and clivus-canal angle significantly improved. For all patients, the postoperative cervicomedullary angle, width of subarachnoid space, CVJ area, and width of syrinx all demonstrated significant improvement, indicating the relief of neural compression. All patients showed significant improvement in both symptoms and clinical assessments. CONCLUSION Severe atlantoaxial joint locking or ligament contracting are the fundamental cause of reduction and fixation failure. Anterior odontoidectomy is indicated for patients with robust bony fusion of the atlantoaxial joint in an unreduced position. The PFDF technique is safe and effective for patients with incomplete atlantoaxial bony fusion. Preoperative assessment of surgical feasibility and vertebral artery status ensures surgical safety and efficacy.
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Affiliation(s)
- Boyan Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Yueqi Du
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Can Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Maoyang Qi
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Hongfeng Meng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Tianyu Jin
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Guoqing Cui
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Jian Guan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Wanru Duan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Zan Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
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Song Z, Zhang K, Li G, Zhang Z, Zheng J, Ran M, Luo J, Wang Z, Chen W. Clinical effect and prognosis of transoral or endoscope-assisted transoral release for irreducible atlantoaxial dislocation: A retrospective cohort study. Heliyon 2024; 10:e35298. [PMID: 39170415 PMCID: PMC11336608 DOI: 10.1016/j.heliyon.2024.e35298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/23/2024] [Accepted: 07/25/2024] [Indexed: 08/23/2024] Open
Abstract
Background The clinical applications of endoscope-assisted transoral release for irreducible atlantoaxial dislocations are limited. This study aimed to investigate the clinical effect and prognostic factors of traditional and endoscope-assisted transoral release, as well as posterior reduction and fixation, in treating irreducible atlantoaxial dislocations. Materials and methods We conducted a retrospective study on 59 patients with irreducible atlantoaxial dislocation who underwent either traditional or endoscope-assisted transoral release, posterior fixation, and fusion between January 2018 and January 2023. Various data, including surgical time, blood loss, drainage volume, oral intake, hospital stay, complications, and neurological status (assessed by the Japanese Orthopedic Association [JOA] score and Oswestry Disability Index [ODI]), were recorded. Imaging parameters such as the atlantodontoid interval (ADI), space available for the cord (SAC), and cervicomedullary angle (CMA) were analyzed and compared. In addition, the correlation between ODI, JOA and patient age, course of disease, preoperative ADI, SAC and CMA were analyzed. Results No significant differences were observed in age, sex, BMI, preoperative ADI, preoperative SAC, or preoperative CMA. All patients achieved excellent reduction with no significant differences between the two groups. Patients in the endoscopic group experienced significantly reduced blood loss, earlier oral intake, and shorter hospital stays compared to those in the open group (P < 0.05). The ODI and JOA scores improved significantly in both groups at 1, 6, 12, 18, and 24 months postoperatively (P < 0.05). Postoperative ADI, SAC, and CMA values in both groups were significantly better than preoperative values (P < 0.001). The patient age, course of disease and the preoperative ADI were negatively correlated with the postoperative ODI and the JOA improvement ratio (P < 0.01), and the preoperative SAC and preoperative CMA had positive correlations with the postoperative ODI and the JOA improvement ratio (P < 0.01) at 6, 12 and 24 months postoperatively. Conclusion Patient age, course of disease, preoperative ADI, SAC and CMA are correlated with the operative prognosis of irreducible atlantoaxial dislocation. The endoscope-assisted transoral approach, compared to the traditional transoral approach, is minimally invasive, resulting in less operative blood loss, earlier oral intake and a shorter length of hospital stay, which could be offered as an alternative for irreducible atlantoaxial dislocation.
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Affiliation(s)
- Zhaojun Song
- Spine Surgery Department of Suining Central Hospital, Sichuan, People's Republic of China
- College of Biomedical Engineering, Chongqing Medical University, Chongqing, People's Republic of China
| | - Kai Zhang
- Operation Room of Suining Central Hospital, Sichuan, People's Republic of China
| | - Guangzhou Li
- Spine Surgery Department of Suining Central Hospital, Sichuan, People's Republic of China
| | - Zhi Zhang
- Spine Surgery Department of Chengdu Fifth People's Hospital, Sichuan, People's Republic of China
| | - Jiazhuang Zheng
- Spine Surgery Department of Suining Central Hospital, Sichuan, People's Republic of China
| | - Maobo Ran
- Spine Surgery Department of Suining Central Hospital, Sichuan, People's Republic of China
| | - Juan Luo
- Medical Record Department of Suining Central Hospital, Sichuan, People's Republic of China
| | - Zhiqiang Wang
- Spine Surgery Department of Suining Central Hospital, Sichuan, People's Republic of China
| | - Wenzhi Chen
- College of Biomedical Engineering, Chongqing Medical University, Chongqing, People's Republic of China
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Ma X, Zou X, Chen J, Yang H, Ma R, Chen Z, Cai M, Xia H. The development of posterior reduction forceps for atlantoaxial dislocation and its preliminary application in irreducible atlantoaxial dislocation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:3043-3048. [PMID: 38750099 DOI: 10.1007/s00586-024-08298-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/04/2024] [Accepted: 05/01/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE To develop posterior reduction forceps for atlantoaxial dislocation and evaluate the preliminary clinical application of this forceps in assisting simple posterior screw-rod system reduction and fixation in the treatment of irreducible atlantoaxial dislocation. METHODS Based on the posterior atlantoaxial screw-rod system, posterior reduction forceps was developed to assist simple posterior screw-rod system for the treatment of irreducible atlantoaxial dislocation. From January 2021 to October 2022, 10 cases with irreducible atlantoaxial dislocation were treated with this technique. The Japanese Orthopaedic Association (JOA) score was applied before and after surgery to evaluate the neurological status of the patient, and the Atlanto-dental interval (ADI) was measured before and after surgery to evaluate the atlantoaxial reduction. X-ray and CT were performed to evaluate internal fixation, atlantoaxial sequence and bone graft fusion during regular follow-up. MRI was performed to evaluate the status of atlantoaxial reduction and spinal cord compression after surgery. RESULTS All 10 patients were successfully operated, and there were no complications such as spinal nerve and vascular injury. Postoperative clinical symptoms were significantly relieved in all patients, and postoperative JOA score and ADI were significantly improved compared with those before surgery (P < 0.05). CONCLUSIONS The developed posterior reduction forceps for atlantoaxial dislocation can assist the simple posterior screw-rod system in the treatment of irreducible atlantoaxial dislocation to avoid the release in anterior or posterior approach and reduce the difficulty of surgery. The preliminary results of this technique are satisfactory and it has a good application prospect.
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Affiliation(s)
- Xiangyang Ma
- Department of Spine, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou, 510010, People's Republic of China.
- The First School of Clinical Medicine, Southern Medical University, No. 1838 North of Guangzhou Road, Guangzhou, 510515, People's Republic of China.
| | - Xiaobao Zou
- Department of Spine, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Junlin Chen
- Department of Spine, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou, 510010, People's Republic of China
- The First School of Clinical Medicine, Southern Medical University, No. 1838 North of Guangzhou Road, Guangzhou, 510515, People's Republic of China
| | - Haozhi Yang
- Department of Spine, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Rencai Ma
- Department of Spine, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou, 510010, People's Republic of China
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, People's Republic of China
| | - Zexin Chen
- Department of Spine, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou, 510010, People's Republic of China
- The First School of Clinical Medicine, Southern Medical University, No. 1838 North of Guangzhou Road, Guangzhou, 510515, People's Republic of China
| | - Mandi Cai
- Department of Spine, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou, 510010, People's Republic of China
- The First School of Clinical Medicine, Southern Medical University, No. 1838 North of Guangzhou Road, Guangzhou, 510515, People's Republic of China
| | - Hong Xia
- Department of Spine, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou, 510010, People's Republic of China
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Zhou M, Sun P, Du Y, Zeng G, Chen Z, Duan W. Posterior intra-articular distraction technique to treat pediatric atlantoaxial instability. Childs Nerv Syst 2024; 40:2153-2160. [PMID: 38498172 DOI: 10.1007/s00381-024-06358-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 03/03/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Surgical treatment for atlantoaxial instability in pediatric patients is challenging. We report our experience with posterior intra-articular distraction technique in treating this disorder. METHODS This is a retrospective descriptive study which included 15 patients of atlantoaxial instability whose age was less than 16 years at the time of clinical presentation. All patients underwent anterior soft tissue released through a posterior-only approach, followed by intra-facet cage implantation, cantilever correction, and instrumentation. Clinical results were measured using the Japanese Orthopedic Association (JOA) scale and radiographic measurements including the atlantodental interval (ADI), posterior atlantodental interval (pADI), the distance of odontoid tip above Chamberlain's line, clivuscanal angle (CCA), and triangular area (TA) of craniovertebral junction. RESULTS The follow-up period ranged from 18 to 72 months, with an average of 41.2 ± 15.2 months. The JOA score increased from 13.6 ± 2.3 to 16.6 ± 0.8. ADI decreased from 4.31 ± 2.37 to 1.85 ± 1.09 mm, and TA decreased from 261.96 ± 107.99 to 197.12 ± 72.37 mm2. pADI increased from 12.89 ± 3.52 to 18.25 ± 3.89 mm, and CCA improved from 132.19 ± 16.34 to 144.35 ± 13.91°. All changes in measurements showed statistically significant. There were no evidence of surgery-related complications or iatrogenic secondary cervical deformity during follow-up. Radiological evaluation showed satisfactory corrections and bony fusions of C1-2 facet joint in all cases. CONCLUSION Posterior intra-articular distraction followed by cage implantation and cantilever correction can be one of the safe and effective ways to solve atlantoaxial instability in pediatric patients.
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Affiliation(s)
- Mading Zhou
- Departments of Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun St., Xicheng Distr., Beijing, China
- Di Rocco Center of Pediatric Neurosurgery, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Peng Sun
- Departments of Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun St., Xicheng Distr., Beijing, China
- Di Rocco Center of Pediatric Neurosurgery, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Yueqi Du
- Departments of Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun St., Xicheng Distr., Beijing, China
- Neurospine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Gao Zeng
- Departments of Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun St., Xicheng Distr., Beijing, China
- Di Rocco Center of Pediatric Neurosurgery, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Zan Chen
- Departments of Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun St., Xicheng Distr., Beijing, China.
- Neurospine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China.
| | - Wanru Duan
- Departments of Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun St., Xicheng Distr., Beijing, China.
- Neurospine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China.
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Wang J, Yang H, Chen Y, Liu G, Xie N, Zhang S, Qiao G. A Method to Evaluate the Reduction Difficulty of Atlantoaxial Dislocation Based on Computed Tomography Quantitative Analysis. World Neurosurg 2024; 185:e283-e290. [PMID: 37683914 DOI: 10.1016/j.wneu.2023.08.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND To evaluate the difficulty of reduction of congenital atlantoaxial dislocation with or without os odontoideum or basilar invagination based on computed tomography (CT) quantitative analysis. METHODS From March 2018 to December 2022, the CT features of 108 patients with atlantoaxial dislocation with or without os odontoideum or basilar invagination were analyzed. Quantitative scores were defined according to imaging features, including sloping of the lateral mass; osteophyte between the lateral mass joint; ball-and-socket deformity of the lateral mass joint; vertical interlocking of the lateral mass joint; callus between the lateral mass joint; and atlanto-odontoid joint hyperplasia, blocking, or fusion. Grades were calculated according to the sum of points of the atlanto-odontoid joint and lateral mass joints, as follows: I, 0-1 points; Ⅱ, 2-3 points; Ⅲ, 4-6 points; IV, 7-10 points. After 1 week of bidirectional cervical traction, CT scans were performed, and atlantodens interval and vertical distance from dens to Chamberlain line were measured. The vertical reduction rate, horizontal reduction rate, and overall reduction rate of atlantoaxial dislocation were calculated. RESULTS The vertical distance from dens to Chamberlain line values after traction were significantly reduced compared with before traction, including grades I, II, III, and IV. The overall reduction rates were 85.1% ± 11.8%, 65.8% ± 8.3%, 45.0% ± 8.5%, and 38.4% ± 13.0% respectively, after 1 week of bidirectional cervical traction. CONCLUSIONS The CT quantitative score system is an effective noninvasive evaluation to judge the reduction difficulty of atlantoaxial dislocation with or without os odontoideum or basilar invagination.
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Affiliation(s)
- Jianhua Wang
- Department of Orthopedics, General Hospital of Southern Theatre Command, Guangzhou, China; Southern Medical University, Guangzhou, China.
| | - Haozhi Yang
- Department of Orthopedics, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Yuyue Chen
- Department of Orthopedics, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Guoqiang Liu
- Department of Orthopedics, General Hospital of Southern Theatre Command, Guangzhou, China; Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ningling Xie
- Department of Orthopedics, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Shuang Zhang
- Department of Orthopedics, General Hospital of Southern Theatre Command, Guangzhou, China
| | - Guoqing Qiao
- Department of Orthopedics, General Hospital of Southern Theatre Command, Guangzhou, China
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Meng H, Xin Z, Zhang B, Qi M, Du Y, Duan W, Chen Z. A Global Bibliometric and Visualization Analysis of Craniovertebral Junction Bony Abnormalities Based on VOSviewer and Citespace. World Neurosurg 2024; 185:e1361-e1371. [PMID: 38522787 DOI: 10.1016/j.wneu.2024.03.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/16/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE Recent years have witnessed a rapidly growing interest in CVJ bony abnormalities, and a qualitative and quantitative analysis of relevant literatures is necessary. This study aims to identify and summarize the published articles related to craniovertebral junction bony abnormalities, to analyze and visualize the current research trends and major contributors. METHODS We collected data from Web of Science, excluding certain article types. Two researchers screened articles for relevance. Data were organized with EndnoteX9, and analyzed using VOSviewer and CiteSpace for co-authorship, co-occurrence, keyword burst, and co-citation analyses to identify research trends and collaborations. RESULTS A total of 2,776 articles were included, revealing an increasing trend in annual publications of CVJ bony abnormalities. The USA was the leading country. King Edward Memorial Hospital was the most prolific institution, and Seth GS Medical College had the most citations. The Spine is the most popular journal with the highest number of publications and citations. Professor Goel Atul from India emerged as the most influential pioneer in this field. Keyword analysis highlighted surgical techniques, diagnosis, and anatomy as the primary research hotspots and Fixation, Placement, and Basilar invagination gradually become the new research trend. However, there is a relative weakness in basic research and epidemiology. CONCLUSIONS This study provides valuable insights into the current research trends and critical contributors in CVJ bony abnormalities, guiding evidence-based decisions and fostering international collaborations to advance knowledge in this field.
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Affiliation(s)
- Hongfeng Meng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Zong Xin
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Boyan Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Maoyang Qi
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Yueqi Du
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Wanru Duan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China
| | - Zan Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute (CHINA-INI), Beijing, China.
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Wang J, Xu T, Pu L, Mai E, Guo H, Sheng J, Deng Q, Liao Y, Sheng W. Release, reduction, and fixation of one-stage posterior approach for basilar invagination with irreducible atlantoaxial dislocation. Br J Neurosurg 2024; 38:249-255. [PMID: 33345635 DOI: 10.1080/02688697.2020.1861217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 11/21/2020] [Accepted: 11/30/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE We evaluate the efficacy, safety and indications of single stage posterior release, reduction, and fixation of basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD). MATERIALS AND METHODS Seventeen patients with BI and IAAD consecutively underwent one-stage release, reduction, and fixation by a posterior approach from July 2000 to June 2015 were followed up for at least 12 months. There were 8 males. Mean age was 56 35.2 ± 13.8 years (range 12-56). The clinical symptoms and signs of the patients were recorded. Pre- and postoperative imaging examinations were performed. Neurological function was assessed using the Japanese Orthopedic Association (JOA) and Ranawat scores. RESULTS Average follow-up time was 47.4 months (12-97 months). The JOA score increased from preoperative 4-10 (8.06 ± 2.52) to postoperative 13-16 (15.20 ± 0.62). The preoperative Chamberlain line, McRae line, Wackenheim line, atlantodens interval, and cervico medullary angle were 12.52 ± 5.17 mm, 6.59 ± 3.04 mm, 6.96 ± 4.32 mm, 9.88 ± 1.93 mm, and 115.35 ± 12.40°, respectively. The postoperative values were 2.0 ± 3.67 mm, -3.06 ± 1.85 mm, -1.76 ± 2.88 mm, 1.17 ± 1.18 mm, and 136.76 ± 11.44°, respectively. CONCLUSION One-stage release, reduction, and fixation for patients with BI and IAAD through a posterior approach is safe and efficient.
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Affiliation(s)
- Jian Wang
- Department of Orthopaedics, The Karamay Central Hospital of Xin Jiang, Karamay, China
| | - Tao Xu
- Department of Orthopaedics, The 1st Affiliated Hospital of Xinjiang Medical University, Urmuqi, China
| | - Lati Pu
- Department of Orthopaedics, The 1st Affiliated Hospital of Xinjiang Medical University, Urmuqi, China
| | - Erdan Mai
- Department of Orthopaedics, The 1st Affiliated Hospital of Xinjiang Medical University, Urmuqi, China
| | - Hailong Guo
- Department of Orthopaedics, The 1st Affiliated Hospital of Xinjiang Medical University, Urmuqi, China
| | - Jun Sheng
- Department of Orthopaedics, The 1st Affiliated Hospital of Xinjiang Medical University, Urmuqi, China
| | - Qiang Deng
- Department of Orthopaedics, The 1st Affiliated Hospital of Xinjiang Medical University, Urmuqi, China
| | - Yi Liao
- Department of Orthopaedics, The Karamay Central Hospital of Xin Jiang, Karamay, China
| | - Weibin Sheng
- Department of Orthopaedics, The 1st Affiliated Hospital of Xinjiang Medical University, Urmuqi, China
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Kong W, Du Y, Li J, Shao J, Xi Y. The retropharyngeal reduction plate for atlantoaxial dislocation: a finite element analysis. Front Bioeng Biotechnol 2024; 12:1346850. [PMID: 38318194 PMCID: PMC10841548 DOI: 10.3389/fbioe.2024.1346850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024] Open
Abstract
Objective: To investigate the biomechanical properties of the retropharyngeal reduction plate by comparing the traditional posterior pedicle screw-rod fixation by finite element analysis. Methods: Two three-dimensional finite element digital models of the retropharyngeal reduction plate and posterior pedicle screw-rod fixation were constructed and validated based on the DICOM (Digital Imaging and Communications in Medicine) data from C1 to C4. The biomechanical finite element analysis values of two internal fixations were measured and calculated under different conditions, including flexion, extension, bending, and rotation. Results: In addition to the backward extension, there was no significant difference in the maximum von Mises stress between the retropharyngeal reduction plate and posterior pedicle screw fixation under other movement conditions. The retropharyngeal reduction plate has a more uniform distribution under different conditions, such as flexion, extension, bending, and rotation. The stress tolerance of the two internal fixations was basically consistent in flexion, extension, left bending, and right bending. Conclusion: The retropharyngeal reduction plate has a relatively good biomechanical stability without obvious stress concentration under different movement conditions. It shows potential as a fixation option for the treatment of atlantoaxial dislocation.
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Affiliation(s)
| | | | | | | | - Yongming Xi
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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Wang Y, Wang C, Yan M. Myelopathy resulting from degenerative atlantoaxial subluxation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:176-184. [PMID: 37659971 DOI: 10.1007/s00586-023-07860-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/09/2023] [Accepted: 07/07/2023] [Indexed: 09/04/2023]
Abstract
PURPOSE To present the clinical features and treatment strategy of degenerative atlantoaxial subluxation (DAAS). METHODS Patients with DAAS treated in our institution from 2003 to 2020 were retrospectively reviewed. We utilized the Japanese Orthopedic Association (JOA) scale to evaluate the neurologic status and distance of Ranawat et al. (DOR) to measure vertical migration. RESULTS We recruited 40 patients with > 2 years of follow-up and an average age of 62.3 ± 7.7 years. All the patients had myelopathy; only one patient had moderate trauma before exacerbation of symptoms, and the duration of symptoms was 34 ± 36 months. The most frequent radiological features were vertical migration of C1 (100%), sclerosis (100%), and narrowing of the atlantoaxial lateral mass articulations (100%). Two patients underwent transoral release combined with posterior reduction and fusion, and 38 patients underwent posterior reduction and fusion with C1 lateral mass screws-C2 pedicle screws and plate systems only. Forty cases (100%) achieved a solid atlantoaxial fusion, and 38 cases (95%) achieved anatomic atlantoaxial reduction. The JOA score increased from 9.3 ± 2.6 to 14.8 ± 2.1 (P < 0.01). DOR increased from 14.5 ± 2.5 to 17.8 ± 2.2 mm at the final follow-up (P < 0.01). Loosening of the locking caps was detected in one case, bony fusion was achieved, and harvest-site pain was reported in five patients. CONCLUSION DAAS differs from other types of AAS and presents with anterior subluxation combined with vertical subluxation arising from degenerative changes in the atlantoaxial joints. We recommend anatomic reduction as an optimal strategy for DAAS.
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Affiliation(s)
- Yongqiang Wang
- Department of Orthopedics, Peking University Third Hospital, NO. 49 North Garden Road, Haidian District, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Chao Wang
- Department of Orthopedics, Peking University Third Hospital, NO. 49 North Garden Road, Haidian District, Beijing, China.
- Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China.
| | - Ming Yan
- Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Peking University Third Hospital, Beijing, China
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Lu C, Duan W, Zhang C, Du Y, Wang X, Ma L, Wang K, Wu H, Chen Z, Jian F. Correlation Among Syrinx Resolution, Cervical Sagittal Realignment, and Surgical Outcome After Posterior Reduction for Basilar Invagination, Atlantoaxial Dislocation, and Syringomyelia. Oper Neurosurg (Hagerstown) 2023; 25:125-135. [PMID: 37083634 DOI: 10.1227/ons.0000000000000719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/14/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND The correlation among syrinx resolution, occipitoaxial sagittal alignment, and surgical outcome in long-term follow-up seems to have not been clarified. OBJECTIVE To further explore the relationship between the syrinx resolution and occipitoaxial realignment after posterior reduction and fixation in basilar invagination (BI)-atlantoaxial dislocation (AAD) patients with syringomyelia. METHODS A continuous series of 32 patients with BI-AAD and syringomyelia who received direct posterior reduction met the inclusion criteria of this study. Their clinical and imaging data were analyzed retrospectively. Before surgery and at the last follow-up, we used the Japanese Orthopedic Association (JOA) score and the Neck Disability Index (NDI) to assess the neurological status, respectively. The Pearson correlation coefficient and multiple stepwise regression analysis were used to explore the relevant factors that may affect surgical outcomes. RESULTS There were significant differences in atlantodental interval, clivus-axial angle, occiput-C2 angle (Oc-C2A), cervicomedullary angle (CMA), subarachnoid space (SAS) at the foramen magnum (FM), syrinx size, NDI, and JOA score after surgery compared with those before surgery. ΔCMA and the resolution rate of syrinx/cord as relevant factors were correlated with the recovery rate of JOA (R 2 = 0.578, P < .001) and NDI (R 2 = 0.369, P < .01). What's more, ΔSAS/FMD (SAS/FM diameter) and ΔOc-C2A were positively correlated with the resolution rate of syrinx/cord (R 2 = 0.643, P < .001). CONCLUSION With medulla decompression and occipital-cervical sagittal realignment after posterior reduction and fusion for BI-AAD patients with syringomyelia, the structural remodeling of the craniovertebral junction and occipitoaxial realignment could contribute to syringomyelia resolution.
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Affiliation(s)
- Chunli Lu
- Division of Spine, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Neurospine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, CHINA-INI, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Wanru Duan
- Division of Spine, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Neurospine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, CHINA-INI, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Can Zhang
- Division of Spine, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Neurospine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, CHINA-INI, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Yueqi Du
- Division of Spine, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Neurospine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, CHINA-INI, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Xinyu Wang
- Division of Spine, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Neurospine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, CHINA-INI, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Longbing Ma
- Division of Spine, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Neurospine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, CHINA-INI, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Kai Wang
- Division of Spine, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Neurospine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, CHINA-INI, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Hao Wu
- Division of Spine, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Neurospine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, CHINA-INI, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Zan Chen
- Division of Spine, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Neurospine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, CHINA-INI, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
| | - Fengzeng Jian
- Division of Spine, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Neurospine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, CHINA-INI, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Beijing, China
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Wang Y, Song C, Ji Y, Xia J, Chen C, Haque M, Zhuang J, Zhou C, Zu J, Li X, Yan J. Clinical and Radiographic Features of the Atlantoaxial Dislocation Associated With Kashin-Beck Disease. World Neurosurg 2023; 171:e1-e7. [PMID: 36049725 DOI: 10.1016/j.wneu.2022.08.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Keshin-Beck disease (KBD) is a particular type of osteoarthritis that affects many joints. However, the deformity of atlantoaxial joint has been rarely reported in KBD, and therefore its clinical and radiograph features have not been identified. METHODS We reviewed data in 14 patients who were diagnosed with atlantoaxial dislocation (AAD) in KBD at our institution. The demographic data, clinical history, imaging data, operative data, and Japanese Orthopaedic Association score were collected for evaluation. RESULTS The mean age at presentation was 50 ± 1.7 years old. The most common features of AAD in KBD were the osteoarthritis, characterized by hypertrophic dens and anterior arch of the atlas. The average inner anteroposterior diameter (IAPD) of C1 was 28 ± 3.5 mm and the average spinal canal diameter was 14 ± 3.3 mm, which were respectively lower than the control level. Five patients had severe C1 stenosis (IAPD < 26mm). Separated odontoid process, like os odontoideum, was seen 9 patients. The tip of dens fused to C1 was observed in 4 patients; 12 patients had high-riding vertebral artery; and 5 patients had severe C1 stenosis, and they underwent C1 laminectomy with C1-C2 interarticular fusion or occipital-cervical fusion. All the patients displayed neurologic improvement after surgery. CONCLUSIONS The atlantoaxial level could be affected by KBD, which may lead to typical abnormalities and cause AAD. A C1 laminectomy with an C1-C2 interarticular fusion or occipital-cervical fusion is recommended for the patient with severe stenosis.
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Affiliation(s)
- Yufu Wang
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China
| | - Chengchao Song
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China
| | - Ye Ji
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China
| | - Jingjun Xia
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China
| | - Chao Chen
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Moinul Haque
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - Jinpeng Zhuang
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China
| | - Changlong Zhou
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China
| | - Jianing Zu
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China
| | - Xuefeng Li
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China
| | - Jinglong Yan
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China.
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Xu N, Tian Y, Yue L, Yan M, Hung KL, Hou X, Li W, Wang S. Clinical and Surgical Characteristics of Patients with Atlantoaxial Dislocation in the Setting of "Sandwich Fusion": A Case-Control Study. J Bone Joint Surg Am 2023; 105:771-778. [PMID: 36827380 DOI: 10.2106/jbjs.22.01004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND Patients with "sandwich" fusion (concomitant C1 occipitalization and C2-C3 nonsegmentation), a subtype of Klippel-Feil syndrome, are at particular risk for developing atlantoaxial dislocation (AAD). However, the clinical and surgical characteristics of AAD in patients with sandwich fusion have not been clearly defined. METHODS A retrospective case-control study with a large sample size and a minimum 2-year follow-up was performed. From 2000 to 2018, 253 patients with sandwich AAD underwent a surgical procedure; these patients constituted the case group, and a matching number of patients with non-sandwich AAD were randomly selected to form the control group. Clinical data from electronic medical records and various imaging studies were analyzed and compared. The Japanese Orthopaedic Association (JOA) scale was used to evaluate neurological function. RESULTS Patients with sandwich AAD, compared with patients with non-sandwich AAD, had symptom onset at a younger age (34.8 compared with 42.8 years; p < 0.001) and had a higher likelihood for myelopathy (87.4% compared with 74.7%; p < 0.001). Patients with sandwich AAD had a higher incidence of lower cranial nerve palsy (7.9% compared with 0.0%; p < 0.001), a lower preoperative JOA score (13.4 compared with 14.2; p < 0.001), and higher incidences of accompanying Type-I Chiari malformation (20.9% compared with 1.2%; p < 0.001) and syringomyelia (21.3% compared with 1.6%; p < 0.001). Finally, patients with sandwich AAD had higher likelihoods of undergoing transoral release (28.5% compared with 5.1%; p < 0.001) and use of salvage fixation techniques (34.4% compared with 6.3%; p < 0.001), and had lower postoperative results for the JOA score (14.9 compared with 15.9; p < 0.001) and improvement rate (43.8% compared with 58.2%; p < 0.001). CONCLUSIONS Patients with sandwich AAD demonstrated distinct clinical manifestations. Versatility involving the use of various internal fixation techniques and transoral release procedures was frequently required in the surgical management of these patients, and meticulous and personalized preoperative planning would be of paramount importance. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Nanfang Xu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, People's Republic of China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, People's Republic of China
| | - Yinglun Tian
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, People's Republic of China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, People's Republic of China
| | - Lihao Yue
- Peking University Health Science Center, Beijing, People's Republic of China
| | - Ming Yan
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, People's Republic of China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, People's Republic of China
| | - Kan-Lin Hung
- Peking University Health Science Center, Beijing, People's Republic of China
| | - Xiangyu Hou
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, People's Republic of China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, People's Republic of China
| | - Shenglin Wang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China.,Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, People's Republic of China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, People's Republic of China
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Huang H, Sheng M, Zeng G, Sun C, Li R. Establish a new parameter "horizontal view-axial angle" and explore its role in the treatment of atlantoaxial instability diseases. Front Surg 2023; 9:947462. [PMID: 36684255 PMCID: PMC9852530 DOI: 10.3389/fsurg.2022.947462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/21/2022] [Indexed: 01/08/2023] Open
Abstract
Objective The objective of the study is to establish a new parameter that can be clearly measured on x-ray images to complement the description of the sagittal alignment of the craniocervical junction. The authors anticipate that this new parameter will enhance surgeons' understanding of the sagittal alignment of the craniocervical junction and play a positive role in the guidance of intraoperative reduction and in the evaluation of postoperative outcomes of patients with atlantoaxial instability. Methods From November 2018 to June 2020, a total of 159 asymptomatic subjects who underwent frontal and lateral cervical x-ray examination in the Second Affiliated Hospital of Soochow University were included in the study. Age, gender, previous spinal trauma, and disease history of each subject were recorded. After screening, 127 effective samples were finally obtained. When taking lateral cervical radiographs, all subjects placed their neck in a neutral position and looked straight ahead with both eyes. On the obtained lateral x-ray images, a straight line was drawn from the radix to the anterior clinoid process; another line was made along the posterior edge of the C2 vertebral body; and the angle between the two lines was measured, which was defined as the "horizontal view-axial angle." The angle formed by the tangent of the posterior edge of the C2 vertebra and C7 vertebral body is the "C2-C7 angle," which was used to describe the curvature of the lower cervical vertebra. The normal range of horizontal view-axial angle and its relationship with C2-7 angle were evaluated. Results The average C2-C7 angle of male subjects was (14.0° ± 7.4°), while that of female subjects was (11.09° ± 7.36°). The average horizontal view-axial angle of male subjects was (92.79° ± 4.52°), and that of female subjects was (94.29° ± 4.50°). Pearson correlation test showed that there was a significant negative correlation between horizontal view-axis angle and C2-C7 angle. Conclusions For patients with atlantoaxial instability diseases, the horizontal view-axis angle is expected to be a sagittal parameter to guide the intraoperative reduction and evaluate postoperative outcomes.
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Affiliation(s)
- Hongxiang Huang
- Department of Neurosurgery, Hainan General Hospital, Haikou, China
| | - Minfeng Sheng
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Guangliang Zeng
- Department of Neurosurgery, Changshu No. 2 Peoples’ Hospital, Changshu, China
| | - Chao Sun
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Rujun Li
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, China,Correspondence: Rujun Li
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Qu Y, Du Y, Zhao Y, Li J, Luo H, Zhou J, Xi Y. The clinical validity of atlantoaxial joint inclination angle and reduction index for atlantoaxial dislocation. Front Surg 2023; 9:1028721. [PMID: 36684329 PMCID: PMC9852502 DOI: 10.3389/fsurg.2022.1028721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/22/2022] [Indexed: 01/09/2023] Open
Abstract
Objective Atlantoaxial dislocation patients with neurological defects require surgery. Sometimes, release surgery is necessary for irreducible atlantoaxial dislocation to further achieve reduction. Whether release surgery is essential relies on the surgeon's experience and lacks objective reference criteria. To evaluate the value of atlantoaxial joint inclination angle (AAJI) in sagittal and coronal planes and reduction index (RI) in the surgical approach selection for atlantoaxial dislocation. Methods Retrospectively analyzed 87 cases (42 males and 45 females, 9-89 years) of atlantoaxial dislocation from January 2011 to November 2020. In addition, 40 individuals without atlantoaxial dislocation were selected as the control group. Imaging parameters were compared between the two groups. According to surgical methods, the experiment group was divided into two groups including Group A(release surgery group) and Group B (conventional operation group). The parameters were measured based on CT and x-ray. The relevant imaging parameters and clinical scores, including the AAJI in sagittal and coronal planes, the atlas-dens interval (ADI) before and after traction, the RI, and JOA scores were measured and analyzed. Results The sagittal and coronal atlantoaxial joint inclination angles(SAAJI and CAAJI) in the control group were 7.91 ± 0.42(L), 7.99 ± 0.39°(R), 12.92 ± 0.41°(L), 12.97 ± 0.37°(R), in A were 28.94 ± 1.46°(L), 28.57 ± 1.55°(R), 27.41 ± 1.29°(L), 27.84 ± 1.55°(R), and in B were 16.16 ± 0.95°(L), 16.80 ± 1.00°(R), 24.60 ± 0.84°(L), 24.92 ± 0.93°(R) respectively. Statistical analysis showed that there was a statistical difference in the SAAJI between the control group and the experiment group (P < 0.01), as well as between groups A and B (P < 0.01). The RI in groups A and B was 27.78 ± 1.46% and 48.60 ± 1.22% respectively, and there was also a significant difference between the two groups (P < 0.01). There was negative correlation between SAAJI and RI. Conclusions The SAAJI and RI can be used as objective imaging indexes to evaluate the reducibility of atlantoaxial dislocation. And these parameters could further guide the selection of surgery methods. When the RI is smaller than 48.60% and SAAJI is bigger than 28.94°, anterior release may be required.
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Zou X, Yang H, Fu S, Deng C, Chen J, Ma R, Ma X, Xia H. A novel surgical management for pediatric patients with irreducible atlantoaxial dislocation: Transoral intraarticular cage distraction and fusion with C-JAWS staple fixation. Front Surg 2023; 9:1054695. [PMID: 36684324 PMCID: PMC9852319 DOI: 10.3389/fsurg.2022.1054695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/07/2022] [Indexed: 01/09/2023] Open
Abstract
Background Currently, irreducible atlantoaxial dislocation (IAAD) can be treated by a single transoral approach in one stage to reduce surgical injuries to patients. However, the widely used fixation devices are not suitable for pediatric patients because of larger profile of devices. Objective The purpose of this study is to report the preliminary clinical outcomes of a novel surgical technique by transoral intraarticular cage distraction and fusion with C-JAWS staple fixation for pediatric patients with IAAD. Methods From June 2011 to June 2014, eight pediatric patients with IAAD were enrolled and treated by this technique in our department. Patients' clinical data were retrospectively analyzed, including neurological status, clinical symptoms, reduction, bone fusion, and complications. Results The surgeries were successfully performed in all patients without injuries to spinal cord, nerve and blood vessel. Clinical symptomatic relief was presented on all 8 patients (100%). Satisfactory reduction was indicated by significant decrease of atlanto-dental interval postoperatively (P < 0.05). The remarkable improvement of postoperative neurological function has been proved by significant increase of Japanese Orthopaedic Association score (P < 0.05). The average follow-up duration was 19.4 ± 5.8 months (range 12-30 months). Bone fusion was achieved in all 8 cases. No complications were documented after operation and during follow-up. Conclusions Transoral intraarticular cage distraction and fusion with C-JAWS staple fixation is an effective treatment for pediatric patients with IAAD, which can achieve satisfactory reduction, fixation and bone fusion.
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Affiliation(s)
| | | | | | | | | | | | | | - Hong Xia
- Correspondence: Xiangyang Ma Hong Xia
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17
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Treatment of irreducible atlantoaxial dislocation by bony deformity osteotomy, remodeling, releasing, and plate fixating through transoral approach. INTERNATIONAL ORTHOPAEDICS 2023; 47:209-224. [PMID: 36331596 DOI: 10.1007/s00264-022-05604-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Investigate a novel method for treating irreducible atlantoaxial dislocation (IAAD) or with basilar invagination (BI) by bony deformity osteotomy, remodeling, releasing, and plate fixating through transoral approach. METHOD From March 2015 to December 2019, 213 consecutive patients diagnosed as IAAD/BI were treated with transoral bony deformity remodeling and releasing combined with plate fixation. The main clinical symptoms include neck pain, headache, numbness of the limbs, weakness, unstable walking, inflexible hand-held objects, and sphincter dysfunction. The bony factors that impact reduction were divided into as follows: type A1 (sloping of upper facet joint in C2), type A2 (osteophyte in lateral mass joints between C1 and C2), type A3 (ball-and-socket deformity of lateral mass joint), type A4 (vertical interlocking between lateral mass joints of C1-C2), type A5 (regional bone fusion in lateral mass joints), type B1 (bony factor hindering reduction between the atlas-dens gap), type B2 (uncinate odontoid deformity), and type B3 (hypertrophic odontoid deformity). All of them were treated with bony deformity osteotomy, remodeling, and releasing techs. RESULT The operation time was 144 [Formula: see text] 25 min with blood loss of 102 [Formula: see text] 35 ml. The average pre-operative ADI improved from 7.5 [Formula: see text] 3.2 mm pre-surgery to 2.5 [Formula: see text] 1.5 mm post-surgery (p < 0.05). The average VDI improved from 12.3 [Formula: see text] 4.8 mm pre-surgery to 3.3 [Formula: see text] 2.1 mm post-surgery (p < 0.05). The average pre-operative CMA improved from 115 [Formula: see text] 25° pre-surgery to 158 [Formula: see text] 21° post-surgery (p < 0.05); the pre-operative CAA changed from 101 [Formula: see text] 28° pre-surgery to 141 [Formula: see text] 10° post-surgery. After the operation, the clinic symptoms improved, and the JOA score improved from 9.3 [Formula: see text] 2.8 pre-operatively to 13.8 [Formula: see text] 2.5 in the sixth months of follow-up. CONCLUSION In addition to soft tissue factors, bony obstruction was another important factor impeding atlantoaxial reduction. Transoral bony deformity osteotomy, remodeling, releasing combined with plate fixating was effective in treating IAAD/BI with bony obstruction factors.
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Hou Z, Fan T, Fan W, Jian Q, Wang Y. Basilar invagination without atlantoaxial dislocation: treatment by correction of clivus canal angle with interfacet distraction and fixation. BMC Musculoskelet Disord 2022; 23:1138. [PMID: 36581884 PMCID: PMC9798678 DOI: 10.1186/s12891-022-06102-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/19/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND This study reports on the surgical technique used and clinical outcomes obtained during the treatment of basilar invagination (BI) without atlantoaxial dislocation (AAD) through the correction of the clivus canal angle (CCA) using interfacet distraction and fixation. METHODS Nineteen cases with BI without AAD treated by the correction of the clivus canal angle were retrospectively analyzed. Pre- and postoperative computed tomography scans and three-dimensional reconstruction views were obtained to measure the size of the CCA, pB-C2 distance, and degree of BI. Chiari malformation and syringomyelia were evaluated by magnetic resonance imaging (MRI). The clinical outcomes for all patients were measured using the Japanese Orthopedic Association (JOA) scale. The CCA was corrected by using interfacet distraction and fixation techniques. The Wilcoxon test was used to compare pre- and postoperative measurements. RESULTS All the patients were followed up for 24.95 ± 5.22 months (range 12-36 months); no patient suffered intraoperative nerve or vascular injury. Clinical symptoms improved in 17 patients (89.5%). The mean JOA score increased from 12.32 ± 1.89 to 14.37 ± 1.30 (Z = -3.655, P < 0.001). The mean CCA improved from 129.34 ± 8.52° preoperatively to 139.75 ± 8.86° postoperatively (Z = -3.824, P < 0.001). The mean pB-C2 decreased from 7.47 ± 2.21 to 5.68 ± 3.13 (Z = -3.060, P = 0.002). Syringomyelia was significantly reduced in 10 out of 13 patients by the first follow-up year. All patients achieved bony fusion. CONCLUSION Posterior interfacet distraction and fixation to correct the CCA is a feasible and effective method for treating BI without AAD.
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Affiliation(s)
- Zhe Hou
- grid.478016.c0000 0004 7664 6350Department of Neurosurgery, Beijing Luhe Hospital, Capital Medica University, Beijing, People’s Republic of China ,grid.24696.3f0000 0004 0369 153XSpine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Tao Fan
- grid.24696.3f0000 0004 0369 153XSpine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Wayne Fan
- grid.17091.3e0000 0001 2288 9830Faculty of Science, The University of British Columbia, Vancouver, BC Canada
| | - Qiang Jian
- grid.24696.3f0000 0004 0369 153XSpine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yinqian Wang
- grid.24696.3f0000 0004 0369 153XSpine Center, Sanbo Brain Hospital, Capital Medical University, Beijing, People’s Republic of China
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Kataria R, Mehrotra M, Purohit DK, Gupta A, Rathore M. Prediction of the functional and radiological outcome on the basis of independent factors with special emphasis on the use of 3D printed models in craniovertebral junction surgery. Surg Neurol Int 2022; 13:369. [PMID: 36128135 PMCID: PMC9479533 DOI: 10.25259/sni_998_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 07/26/2022] [Indexed: 11/04/2022] Open
Abstract
Background: The aim of the study was to evaluate the advantage of performing planned surgery using customized three-dimensional (3D) printed models versus performing surgery without using 3D printed models in patients with craniovertebral junction (CVJ) anomalies and traumatic CVJ fractures and dislocations. Methods: Forty-two patients with CVJ anomalies, who were planned for operative intervention in the Department of Neurosurgery at SMS Hospital from March 2019 to February 2021, were randomly divided into two groups and analyzed. First group was operated after rehearsal on a customized 3D printed model whereas the second group underwent operative intervention without the rehearsal of surgery on the 3D printed model. Results: Forty-two patients were enrolled for the study. Twenty-five of these patients had developmental CVJ anomalies, 16 had post traumatic Atlantoaxial dislocation (AAD), and one had congenital AAD. Twenty-three patients underwent surgical intervention using 3D printed models and 19 without using 3D printed models. The outcome in the two groups was compared using modified Japanese orthopedic association score (mJOA), recovery rate, incidence of complications such as screw malposition, postoperative neurological deterioration, vertebral artery (VA) injury, and radiological improvement based on Atlanto-Dental interval, the distance of the tip of dens from Wackhenheims clivus canal line, and the distance of tip of dens from the Chamberlain’s line. The improvement in mJOA score postoperatively was found to be statistically significant in study group (P < 0.001) as compared to control group (P = 0.06). Recovery rate was better in study group than in control group (P = 0.023). In study group, the incidence of screw malposition and VA injury was lower than control group. Three patients deteriorated neurologically postoperatively in the control group and none in the study group. The average improvements in the radiological parameters were found to be better in study group as compared to control group postoperatively. Conclusion: The authors conclude that 3D printed models are extremely helpful in analyzing joints and VA anatomy preoperatively and are helpful in unmasking any abnormal bony and vascular anatomy effectively, making the surgeon confident about the placement of the screws intraoperatively. These 3D models help in intraoperative error minimization with better neurological outcomes in postoperative period. In our opinion, these models should be included as a basic investigation tool in patients of CVJ abnormalities. The models also offer other advantages such as preoperative simulation, teaching modules, and patient education.
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Affiliation(s)
- Rashim Kataria
- Department of Neurosurgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India,
| | - Mudit Mehrotra
- Department of Neurosurgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India,
| | | | - Ajay Gupta
- Department of Preventive and Social Medicine, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Monika Rathore
- Department of Preventive and Social Medicine, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
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Zhao G, Song M, Duan W, Chen Z, Xue Y. Biomechanical investigation of intra-articular cage and cantilever technique in the treatment of congenital basilar invagination combined with atlantoaxial dislocation: a finite element analysis. Med Biol Eng Comput 2022; 60:2189-2199. [DOI: 10.1007/s11517-022-02596-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
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Du J, Gao X, Huang Y, Yang X, Zheng B, Liu Z, Hui H, Gao L, Wu J, Zhao Z, He B, Yan L, Hao D. Posterior Surgery in the Treatment of Craniovertebral Junction Deformity with Torticollis. Orthop Surg 2022; 14:2418-2426. [PMID: 35912975 PMCID: PMC9531064 DOI: 10.1111/os.13324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To investigate the clinical effect of posterior surgery in the treatment of craniovertebral junction (CVJ) deformities with torticollis and methods for preventing and treating complications in order to obtain a reasonable treatment strategy. METHODS From January 2007 to December 2017, 78 patients who suffered from CVJ deformities with torticollis treated by posterior surgery were analyzed. The surgical techniques were all posterior correction and fusion to restore the anatomical alignment of the craniovertebral junction. The visual analog score (VAS) and Short Form-36 (SF-36) health survey questionnaire were utilized to evaluate preoperative and postoperative neck pain, and changes in the torticollis angle and atlas-dens interval (ADI) were evaluated through anteroposterior X-ray and computed tomography. Intra- and postoperative complications were all recorded. One-way ANOVA, LSD-t test, and χ2 test were performed to evaluate the difference between the preoperative and postoperative data. RESULTS The mean follow-up time was 37.4 ± 15.7 months, the average operation time was 115.6 ± 12.8 min, and the average blood loss was 170.8 ± 26.3 mL. According to the deformity site, the range of posterior correction and fusion was as follows: 38 cases of C1 -C2 , 33 cases of C0 -C2 , and seven cases of C0 -C3 . The preoperative SF-36, VAS, torticollis angle, and ADI were 42.6 ± 8.8, 4.8 ± 1.1, 37.2 ± 11.2°, and 4.9 ± 2.3 mm, respectively. The difference was significant at 3 months post operation (p < 0.05), and there was no significant difference at the final follow-up compared with 3 months post operation (p > 0.05). CONCLUSION It can objectively achieve favorable correction and satisfactory clinical effects under posterior correction and fixation for CVJ deformities with torticollis. Intra- and postoperative complications can be settled by proper management.
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Affiliation(s)
- Jinpeng Du
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'an CityChina
| | - Xiangcheng Gao
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'an CityChina,Yan'an UniversityYan'an CityChina
| | - Yunfei Huang
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'an CityChina
| | - Xiaobin Yang
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'an CityChina
| | - Bolong Zheng
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'an CityChina
| | - Zhongkai Liu
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'an CityChina
| | - Hua Hui
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'an CityChina
| | - Lin Gao
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'an CityChina
| | - Jiayuan Wu
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'an CityChina
| | - Zhigang Zhao
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'an CityChina
| | - Baorong He
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'an CityChina
| | - Liang Yan
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'an CityChina
| | - Dingjun Hao
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'an CityChina
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Atlantoaxial Non-Fusion Using Biomimetic Artificial Atlanto-Odontoid Joint: Technical Innovation and Initial Biomechanical Study. Spine (Phila Pa 1976) 2022; 47:825-832. [PMID: 34618789 DOI: 10.1097/brs.0000000000004259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A biomechanical in vitro investigation. OBJECTIVE To evaluate the function and stability of self-designed biomimetic artificial atlanto-odontoid joint (BAAOJ) replacement on the atlantoaxial joint. SUMMARY OF BACKGROUND DATA Upper cervical fusion surgery is a common treatment for various atlantoaxial disorders, and favorable clinical outcome has been achieved. However, the fusion surgery results in loss of atlantoaxial motion as well as adjacent segments degeneration, reducing the quality of life of patients and might produce severe neurological symptoms. Non-fusion technology is expected to solve the above problems, but various designed devices have certain defects and are still in the exploratory phase. MATERIALS AND METHODS Biomechanical tests were conducted on 10 fresh human cadaveric craniocervical specimens in the following sequence: 1) intact condition, 2) after the BAAOJ arthroplasty, 3) after BAAOJ fatigue test, 4) after odontoidect-omy, and 5) after anterior rigid plate fixation. Three-dimensional movements of the C1-C2 segment were evaluated to investigate the function and stability of BAAOJ arthroplasty compared with the intact condition after the BAAOJ fatigue test, odontoidect-omy, and rigid plate fixation. RESULTS Comparing the BAAOJ implantation to the intact state, the range of motion and neutral zone were slightly reduced in all directions (P > 0.05). Compared with the rigid plate fixation, the BAAOJ implantation significantly increased the range of motion and neutral zone in all directions, especially in the axial rotation (P < 0.05). CONCLUSION We designed a BAAOJ for correcting atlantoaxial disorders arising from atlantoaxial instability. As a non-fusion device, the most critical feature of BAAOJ replacement is the retention of flexion-extension, lateral bending, and axial rotation range of motion similar to the normal state. It can also stabilize the atlantoaxial complex, and the BAAOJ itself has a good initial stability.Level of Evidence: 4.
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Rehman RU, Akhtar MS, Bibi A. Anterior transcervical release with posterior atlantoaxial fixation for neglected malunited type II odontoid fractures. Surg Neurol Int 2022; 13:132. [PMID: 35509576 PMCID: PMC9062967 DOI: 10.25259/sni_237_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/20/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Type 2 odontoid fractures are associated with a high rate of nonunion without surgical treatment. If neglected, they may become fixed in an abnormal position, causing progressive myelopathy. Conventionally, odontoidectomy or transoral release is performed to relieve symptoms in such cases. Here, were report our experience with a transcervical approach for odontoid release (i.e., of a chronically fractured dens) followed by a posterior C1–C2 fusion.
Methods:
The 11 patients (2017–2021) retrospectively included; in this study, all had a history of remote trauma and the radiological appearance of an old odontoid fracture that was displaced and could not be reduced with traction. There were eight males and three females who averaged 52.6 years of age.
Results:
All 11 patients underwent anterior retropharyngeal release with a C4–C5 level incision followed by a posterior C1–C2 fusion. The mean Japanese orthopedic association on presentation was 9.9 ± 2.7 which improved to 13.8 ± 2.7 on final follow-up (P < 0.01). Patients were followed an average of 9.6 months ± 4.4 (mean ± SD) postoperatively during which time they all clinically improved.
Conclusion:
Anterior release through a retropharyngeal approach coupled with posterior C1–C2 instrumentation proved to be an effective alternative to the traditional transoral approach to treat a chronic malunited odontoid fracture.
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Affiliation(s)
| | | | - Amna Bibi
- Department of General Surgery, Hayatabad Medical Complex, Peshawar, Pakistan
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24
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Li W, Wang B, Feng X, Hua W, Yang C. Preoperative management and postoperative complications associated with transoral decompression for the upper cervical spine. BMC Musculoskelet Disord 2022; 23:128. [PMID: 35135526 PMCID: PMC8826709 DOI: 10.1186/s12891-022-05081-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/02/2022] [Indexed: 12/16/2022] Open
Abstract
Purpose This review aimed to describe the preoperative management and postoperative complications associated with transoral decompression of the upper cervical spine, and to clarify the risk factors, related issues and complication management. Methods Studies on transoral decompression for the upper cervical spine were reviewed systematically. The preoperative management and postoperative complications associated with transoral decompression for upper cervical deformities were analyzed. Results Evidence suggests that preoperative management in patients undergoing transoral decompression for the upper cervical spine is closely related to the occurrence of postoperative complications. Hence, preoperative surgical planning, preoperative preparation, and oral nursing care should be seriously considered in these patients. Moreover, while being established as an effective and safe method, transoral decompression is associated with several postoperative complications, which could be prevented by elaborate preoperative management, improved surgical skills, and appropriate precautionary measures. Conclusions The effectiveness and safety of transoral decompression has been improved by the constant development of operative techniques and advanced auxiliary diagnostic and therapeutic methods, with the understanding of the anatomical structure of the craniocervical joint. Therefore, the incidence rates of postoperative complications have decreased. The application of individualized anterior implants and less-invasive endoscopic endonasal approach has improved the effectiveness of transoral decompression and reduced the associated complications.
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Affiliation(s)
- Wenqiang Li
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Bingjin Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiaobo Feng
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Wenbin Hua
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Cao Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Zhu J, Wu J, Luo K, Wang Z, Jin H, Jin Y, Wang Y, Liu M, Liu P. Intraarticular bone grafting in atlantoaxial facet joints via a posterior approach: nonstructural or structural-a minimum 24-month follow-up. J Orthop Surg Res 2021; 16:524. [PMID: 34425867 PMCID: PMC8381565 DOI: 10.1186/s13018-021-02630-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/24/2021] [Indexed: 11/10/2022] Open
Abstract
Objective To investigate the necessity of nonstructural or structural intraarticular bone grafting in atlantoaxial facet joints via a posterior approach and the influence by the presence of basilar invagination (BI). Methods From November 2016 to October 2018, patients who underwent posterior atlantoaxial or occipitocervical arthrodesis surgery at one institute were retrospectively reviewed. Operation records, preoperative and postoperative clinical status, and radiological films were analyzed. Results Thirty-three patients (19 without BI, 14 with BI) underwent posterior facet joint release followed by intraarticular bone grafting were enrolled finally. Twenty-four nonstructural (15 without BI, 9 with BI) and 9 structural (4 without BI, 5 with BI) grafting were performed. The average follow-up was 32.15±6.73 months (24–47 months). Among them, 1 (3.03%) implant failure occurred, and 32 (96.97%) achieved satisfactory neurological outcomes, including 28 (84.85%) complete and 4 (12.12%) acceptable reductions with complete fusion within 6 months. For patients without BI, structural and nonstructural grafting showed no significant difference in terms of reduction maintenance (100% vs 73.33%, p = 0.530), while for those with BI, structural grafting significantly increased the postoperative height of the joint space (5.67±1.22 mm vs 3.43±1.78 mm, p = 0.002) and maintained it much better than nonstructural grafting (88.89% vs 20.00%, p = 0.023), contributing notably to BI correction. Conclusion Intraarticular structural bone grafting in atlantoaxial facet joints has the advantage of maintaining anterior column height in the case of lateral mass collapse or when BI correction is needed; otherwise, nonstructural bone grafting is enough. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02630-z.
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Affiliation(s)
- Jun Zhu
- Division of Spine Surgery, Department of Orthopedics, Daping Hospital of Army Medical University, Chongqing, 400042, China
| | - Jian Wu
- Division of Spine Surgery, Department of Orthopedics, Daping Hospital of Army Medical University, Chongqing, 400042, China
| | - Keyu Luo
- Division of Spine Surgery, Department of Orthopedics, Daping Hospital of Army Medical University, Chongqing, 400042, China
| | - Zhong Wang
- Division of Spine Surgery, Department of Orthopedics, Daping Hospital of Army Medical University, Chongqing, 400042, China
| | - Huaijian Jin
- Division of Spine Surgery, Department of Orthopedics, Daping Hospital of Army Medical University, Chongqing, 400042, China
| | - Yufei Jin
- Division of Spine Surgery, Department of Orthopedics, Daping Hospital of Army Medical University, Chongqing, 400042, China
| | - Yingbo Wang
- Division of Spine Surgery, Department of Orthopedics, Daping Hospital of Army Medical University, Chongqing, 400042, China
| | - Mingyong Liu
- Division of Spine Surgery, Department of Orthopedics, Daping Hospital of Army Medical University, Chongqing, 400042, China.
| | - Peng Liu
- Division of Spine Surgery, Department of Orthopedics, Daping Hospital of Army Medical University, Chongqing, 400042, China. .,State Key Laboratory of Trauma: Burns & Combined Wound, Institute for Traffic Medicine of Army Medical University, No. 10, Changjiangzhilu, Daping Street, Yuzhong District, Chongqing, 400042, China.
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Zhou S, Yuan B, Liu W, Tang Y, Chen X, Jia L. Three-dimensional reduction method with a modified C2 isthmus screw in irreducible atlantoaxial dislocation: a technical note. BMC Surg 2021; 21:324. [PMID: 34384414 PMCID: PMC8362247 DOI: 10.1186/s12893-021-01321-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Three-dimensional reduction plays a vital role in surgical reduction of irreversible atlantoaxial dislocation (IAAD). However, the most commonly used combination of C1 pedicle screw (PS) or lateral mass screw (LMS) and C2 PS or isthmus screw often fails to achieve satisfactory reduction at one time. The difficulty is usually caused by short anteroposterior and vertical distance between heads of C1 and C2 screws, which lack enough space for reduction operation. The objective of this study is to describe a three-dimensional reduction method with a modified C2 isthmus screw and to illustrate its advantage and effectiveness for IAAD. METHODS Twelve patients with IAAD underwent reduction and fixation with modified C2 isthmus screw combined with C1 PS or LMS, fusion with autologous bone graft. The insertion point was lateral to the intersection of caudal edge of C2 lamina and lateral mass, with a trajectory towards C2 isthmus, via lateral mass. The three-dimensional reduction was achieved through pulling and distracting. Radiographic evaluation included anteroposterior and direct distance between different insertion points, the occipitoaxial angle (O-C2A), clivus-canal angle (CCA) and cervicomedullary angle (CMA). Clinical outcomes evaluation included the Japanese Orthopaedic Association (JOA) score, Visual analog scale (VAS) and Neck Disability Index (NDI). RESULTS All the patients maintained effective reduction during the follow-up. The anteroposterior and direct distance was significantly higher in modified C2 isthmus screw than C2 PS whether combined with C1 PS or LMS (P < 0.05). The degree of O-C2A, CCA and CMA, JOA score, NDI, and VAS were significantly improved after the surgery (P < 0.05). CONCLUSIONS Three-dimensional reduction method with a modified C2 isthmus screw is effective and safe in managing IAAD. It can increase the anteroposterior and vertical distance between the heads of C1 and C2 screws, which is benefit for the three-dimensional reduction operation of IAAD.
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Affiliation(s)
- Shengyuan Zhou
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, 200003, People's Republic of China
| | - Bo Yuan
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, 200003, People's Republic of China
| | - Weicong Liu
- Department of Orthopedics, the Second Affiliated Hospital, Hunan Normal University, Changsha, People's Republic of China
| | - Yifan Tang
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, 200003, People's Republic of China
| | - Xiongsheng Chen
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, 200003, People's Republic of China.
| | - Lianshun Jia
- Spine Center, Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai, 200003, People's Republic of China
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Fracture of the Dens Axis Due to Spinal Manifestation of Sarcoidosis: Treatment Option and Review of the Literature. Spine (Phila Pa 1976) 2021; 46:E743-E749. [PMID: 34100842 DOI: 10.1097/brs.0000000000003992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report and literature review. OBJECTIVE We present a case of a pathologic unstable fracture of the odontoid process due to vertebral osseous sarcoidosis. The surgical management of this unreported pathology is described and a review of the literature is given. SUMMARY OF BACKGROUND DATA Sarcoidosis is a chronic inflammatory systemic disease of unknown etiology, characterized by multiorgan noncaseating granulomatous infiltrations. It affects primarily the lungs, lymphatic system, eyes, skin, heart, and nervous system. Osseous sarcoidosis is usually clinically asymptomatic and therefore frequently under-diagnosed. When it does affect the skull or vertebral column, specific surgical therapy is only necessary in cases with nonmanageable pain or where structural integrity is threatened. METHODS Our patient underwent a so-called semiconservative approach, consisting of a minimally invasive transoral-transpharyngeal approach, surgical debridement of the lytic bony lesion, transplantation of cancellous homologous bone, and carbon chest halo-immobilization. Halo-immobilization was left for 8 weeks, followed by a further 6 weeks with a hard cervical collar. RESULTS Routine computed tomography scans 3 days, 6, 12, 18 weeks, and 1 year after surgery showed good filling of the original defect with cancellous bone, correct alignment of the upper cervical spine, and progressive fracture consolidation and stability. Surgical site infection (SSI) was not observed. The patient had no neurological postoperative deficits. After initial dysphagia, swallowing was not permanently impaired. CONCLUSION Sarcoidosis-induced odontoid fractures can be managed successfully using a semiconservative approach, consisting of transoral-transmucosal, minimally invasive surgical procedure for debridement of the lesion and transplantation of cancellous bone with additional halo-immobilization. Permanent fusion of C1-2 with loss of the cervical range of motion is avoided. Despite performing bone surgery in a potentially markedly contaminated site, bacterial infection was not an issue, possibly supported by the temporary discontinuation of immunosuppressive agents and the prudent use of antibiotics.Level of Evidence: 4.
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Transoral release to realign postoperative loss of reduction following occipitocervical fixation for congenital basilar invagination. Spine Deform 2021; 9:1197-1205. [PMID: 33590408 DOI: 10.1007/s43390-021-00303-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Revision surgery in an irreducible atlantoaxial dislocation (IAAD) previously operated with a posterior approach is challenging. Multiple modalities using anterior, posterior, and dual approaches have been described. We report a so far unreported technique of revision surgery by posterior implant removal and decompression with anterior transoral release followed by posterior instrumentation. METHODS 14-year male with basilar invagination (BI) with IAAD, previously operated with posterior decompression and instrumented occipitocervical fusion presented three months later with post-traumatic recurrence of myelopathy with quadriparesis with Di Lorenzo grade 4 and loss of reduction. He was operated with a posterior implant and early fusion mass removal with extended foramen magnum decompression (FMD), followed by anterior transoral release with a satisfactory reduction on traction, and finally, a posterior revision instrumented occipitocervical fusion. RESULTS At 2-year follow-up, the patient was symptom-free with Di Lorenzo grade 1 and cervicomedullary angle improvement from 97.4° to 141.2°; achieving bony fusion. CONCLUSION Single-stage posterior-anterior transoral-posterior approach can be used to achieve satisfactory reduction for a revision BI with IAAD with prior posterior instrumentation.
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Chen Z, Duan W, Chou D, Guan J, Liu Z, Jian Q, Zhang B, Bo X, Jian F. A Safe and Effective Posterior Intra-Articular Distraction Technique to Treat Congenital Atlantoaxial Dislocation Associated With Basilar Invagination: Case Series and Technical Nuances. Oper Neurosurg (Hagerstown) 2021; 20:334-342. [PMID: 33372978 DOI: 10.1093/ons/opaa391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/16/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The management of atlantoaxial dislocation (AAD) associated with basilar invagination (BI) is challenging, and traditional posterior-only approaches lack the ability to release the anterior soft tissue resulting in unsatisfactory reduction. Furthermore, vertebral artery anomalies and deformed anatomy increase surgical risks. OBJECTIVE To introduce a safe and efficient technique to reduce congenital AAD and BI through a single-stage posterior-only approach. METHODS A total of 65 patients with AAD and concomitant BI who had congenital osseous abnormalities were retrospectively analyzed. All patients had anterior soft tissue released through a posterior-only approach, followed by intra-facet cages implantation, cantilever correction, and instrumentation. Clinical results were measured using the Japanese Orthopedic Association (JOA) scale, and radiographic measurements included the atlanto-dental interval, the distance of odontoid tip above Chamberlain's line, clivus-canal angle (CCA), and syrinx length. Paired t-tests were used to compare preoperative and postoperative measurements. RESULTS The mean JOA score increased from 10.98 to 14.40 at 1-yr follow-up. Complete reduction of AAD and BI was achieved in 48 patients (73.8%). The mean CCA improved from 115° preoperatively to 129° postoperatively. Reduction of syrinx size was observed in 14 patients at 1 wk and in 35 patients 1 yr after surgery. All patients achieved bony fusion. CONCLUSION Posterior intra-articular distraction followed by cage implantation and cantilever correction can achieve complete reduction in most cases of congenitally anomalous AAD associated with BI.
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Affiliation(s)
- Zan Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical Universiy. Beijing, China
| | - Wanru Duan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical Universiy. Beijing, China
| | - Dean Chou
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
| | - Jian Guan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical Universiy. Beijing, China
| | - Zhenlei Liu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical Universiy. Beijing, China
| | - Qiang Jian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical Universiy. Beijing, China
| | - Boyan Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical Universiy. Beijing, China
| | - Xuefeng Bo
- School of Biomedical Engineering, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Fengzeng Jian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical Universiy. Beijing, China
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Banga MS, Sandeep B, Saha SK, Roy K, Dixit S, Ghosh P. Atlantoaxial Dislocation: Surgical Outcome following Anterior Retropharyngeal Approach to Odontoid with or without Fixation. INDIAN JOURNAL OF NEUROSURGERY 2021. [DOI: 10.1055/s-0040-1721237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Introduction Atlantoaxial dislocation (AAD) refers to a loss of stability between the atlas and axis vertebra. The conventional transoral approach and the anterior retropharyngeal approach (ARPA) are adequate for the upper cervical vertebral segments. This study was undertaken to evaluate the usefulness of the ARPA to the odontoid in patients of AAD.
Materials and Methods The study was undertaken on 20 patients admitted in Nil Ratan Sircar Medical College and Hospital, Kolkata, India, with functional disability secondary to AAD. These patients underwent surgery through ARPA to odontoid with or without fixation. Patients were analyzed between October 2014 and September 2016.
Results Maximum number of patients belonged to third decade of life. The male to female ratio was 1.5. The mean duration of symptoms was 10.86 months. Weakness of the upper and lower limbs predominated. About 65% patients had axial neck pain. Nine patients (45%) in total had difficulty in either bowel or bladder. Five patients presented with fracture odontoid and pannus formation of the odontoid process, while six had basilar invagination. One patient underwent anterior odontoid screw fixation and the other 19 patients underwent anterior retropharyngeal odontoidectomy with posterior fixation. Two patients expired in the present study. Most of the patients had improvement in Nurick grade during follow-up. Five patients had transient throat pain and dysphagia. Three patients had superficial surgical site infection. One patient had postoperative cerebrospinal fluid leak.
Conclusion The ARPA to odontoid is a feasible approach for decompression and fixation of the odontoid in AAD cases.
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Affiliation(s)
- Manpreet Singh Banga
- Department of Neurosurgery, Vydehi Institute of Medical Sciences and Research, Whitefield, Bangalore, Karnataka, India
| | - B.V. Sandeep
- Department of Neurosurgery, Vydehi Institute of Medical Sciences and Research, Whitefield, Bangalore, Karnataka, India
| | - Suniti Kumar Saha
- Department of Neurosurgery, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Kaushik Roy
- Department of Neurosurgery, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Sourabh Dixit
- Department of Neurosurgery, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
| | - Partha Ghosh
- Department of Neurosurgery, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India
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A novel surgical protocol for safe and accurate placement of C1 lateral mass screws in patients with atlas assimilation, basilar invagination and atlantoaxial instability: technical details, accuracy assessment and perioperative complications. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1585-1595. [PMID: 33704580 DOI: 10.1007/s00586-021-06780-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 10/23/2020] [Accepted: 02/16/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To introduce a novel surgical protocol for safe and accurate placement of C1 lateral mass screws in patients with atlas assimilation, basilar invagination and atlantoaxial instability, and to categorize the screw accuracy and perioperative complications regarding this technique in a large case series. METHODS Between January 2015 and January 2020, patients who had atlas assimilation, basilar invagination and atlantoaxial instability, and underwent atlantoaxial fixation using C1 lateral mass screws were reviewed. C1 lateral mass screws were placed with a novel surgical protocol following a series key steps, including posterior para-odontoid ligament release, panoramic exposure of the invaginated lateral mass, and diligent protection of the abnormal VA. Screw accuracy and related complications were specifically evaluated. RESULTS A total of 434 C1 lateral mass screws were placed. Fifteen screws (3.5%) were classified as unacceptable, 54 screws (12.4%) were classified as acceptable, and 365 screws (84.1%) were classified as ideal. Overall, 96.5% of screws were deemed safe. There were no cases of vascular injury or permanent neurological defects. One patient with an unacceptable screw presented with hypoglossal nerve paralysis and recovered after an immediate revision surgery. Thirty-seven patients complained about occipital neuralgia and were successfully managed with medication. CONCLUSION Placement of C1 lateral mass screws in patients with atlas assimilation, basilar invagination and atlantoaxial instability following this surgical protocol is safe and accurate. Thorough para-odontoid ligamental release, wide exposure of the invaginated lateral mass, and diligent protection of the vertebral artery are critical to maximize the chances of successful screw placement.
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32
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Wang S, Leng H, Tian Y, Xu N, Liu Z. A novel 3D-printed locking cage for anterior atlantoaxial fixation and fusion: case report and in vitro biomechanical evaluation. BMC Musculoskelet Disord 2021; 22:121. [PMID: 33514363 PMCID: PMC7844893 DOI: 10.1186/s12891-021-03987-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 01/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment of atlantoaxial dislocation is aimed at reduction and stabilization of the atlantoaxial joint. 3D printing refers to a process where additive manufacturing is achieved under precise computer control. Literature on its utilization in anterior atlantoaxial fixation and fusion is rare. This study is the first report on a 3D-printed locking cage used in the anterior procedure for atlantoaxial dislocation. METHODS A middle-aged male in his 40s presented with weakness and numbness of his extremities for 3 years and could only walk slowly with assistance. Imaging studies revealed severe anterior migration of C1, irreducible atlantoaxial dislocation, and severe cervical-medullary compression. A preoperative plan consisting of trans-oral soft tissue release and fixation using tailor-designed 3D-printed cages was devised. Following fluoroscopic confirmation of reduction of the atlantoaxial joints, two customized 3D-printed cages made of titanium alloy were inserted into the bilateral facet joints, which were then locked by six screws into the lateral masses of C1 and C2. The microstructure of the inserted cages was optimized for improved biomechanical stability and enhanced osseo-integration, without the need for bone grafting. In addition, a biomechanical test was performed on seven human cadaveric specimens comparing the novel implant with the conventional C1 lateral mass-C2 pedicle screw construct in three modes of motion (flexion-extension, lateral bending, axial rotation). RESULTS Improvement of neurologic function in the patient was evident immediately after surgery. He was able to walk independently 1 month post-operatively. At the 12-month follow-up, coronal reconstruction of CT demonstrated properly-positioned 3D-printed cages, evidence of osseo-integration at the bone-implant interface, and no subsidence or displacement of the implant. Eighteen months out of surgery, the mJOA score improved to 15, and lateral X-ray confirmed reduction of atlanto-axial dislocation. Additionally, the new construct provided strong fixation comparable to that conferred by conventional constructs as there was no significant difference observed between the two groups in all three directions of motion. CONCLUSIONS The novel implant represents a new option in the treatment of irreducible atlantoaxial dislocation. It can provide strong anterior support for solid fixation and fusion with a low profile and a microstructure that obviates the need for bone grafting.
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Affiliation(s)
- Shenglin Wang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
| | - Huijie Leng
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
| | - Yinglun Tian
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
| | - Nanfang Xu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China
| | - Zhongjun Liu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, People's Republic of China.
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Surgical treatment of a complex craniocervical malformation combined with posterior cranial fossa teratoma: a case report and literature review. Chin Neurosurg J 2021; 7:9. [PMID: 33461616 PMCID: PMC7812719 DOI: 10.1186/s41016-020-00230-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 12/28/2020] [Indexed: 11/18/2022] Open
Abstract
Background Basilar invagination (BI) with atlantoaxial dislocation (AAD) is not uncommon in patients with scoliosis, Klippel-Feil syndrome (KFS), and other bone deformities. Cases with combinations of the abovementioned dislocations and deformities with posterior cranial fossa teratoma are rare in the clinic and difficult to handle. Case presentation This case presents a 34-year-old woman diagnosed with atlantoaxial dislocation and posterior cranial fossa mass. After two surgeries, the posterior cranial teratoma was completely removed with satisfactory atlantoaxial reduction. The postoperative 1-year follow-up examination showed that the bone graft fusion was successful, without remaining significant dysfunction. Conclusions The surgical risk of irreducible atlantoaxial dislocation combined with posterior cranial fossa tumor is huge. Thus, it needs to be fully preoperatively evaluated and managed carefully in accordance with sound surgical principles.
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Zou X, Ouyang B, Yang H, Wang B, Ge S, Chen Y, Ni L, Zhang S, Xia H, Yang J, Ma X. Surgical treatment for basilar invagination with irreducible atlantoaxial dislocation: transoral atlantoaxial reduction plate fixation vs occipitocervical fixation. BMC Musculoskelet Disord 2020; 21:825. [PMID: 33292209 PMCID: PMC7724810 DOI: 10.1186/s12891-020-03838-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/25/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Transoral atlantoaxial reduction plate (TARP) fixation or occipitocervical fixation (OF) is an effective treatment for basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD). But, all current clinical studies involved a single surgical procedure. The clinical effects of TARP and OF operation for BI with IAAD have yet to be compared. We therefore present this report to compare the treatment of TARP and OF procedure for BI with IAAD. METHODS Fifty-six patients with BI with IAAD who underwent TARP or OF operation from June 2011 to June 2017 were retrospectively analyzed. Among these, 35 patients underwent TARP operation (TARP group), and 21 patients underwent OF operation (OF group). We compared the difference of clinical, radiological, and surgical outcomes between the TARP and OF groups postoperatively. RESULTS Compared with OF group, the operative time and blood loss in TARP group were lower. There was no statistical difference in the atlantodental interval (ADI), clivus canal angle (CCA), cervicomedullary angle (CMA), distance between the top of the odontoid process and the Chamberlain line (CL) and Japanese Orthopaedic Association (JOA) score between the TARP and OF groups preoperatively, but the improvements of these parameters in the TARP group were superior to those in the OF group postoperatively. The fusion rates were higher in the TARP group than those in the OF group at the early stage postoperatively. CONCLUSIONS TARP and OF operations are effective surgical treatment for BI with IAAD, but the performance of reduction and decompression and earlier bone fusion rates of TARP procedure are superior to those of OF.
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Affiliation(s)
- Xiaobao Zou
- The First School of Clinical Medicine, Southern Medical University, No.1838 North of Guangzhou Road, Guangzhou, 510515, People's Republic of China.,Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Bieping Ouyang
- The First School of Clinical Medicine, Southern Medical University, No.1838 North of Guangzhou Road, Guangzhou, 510515, People's Republic of China.,Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Haozhi Yang
- Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Binbin Wang
- Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Su Ge
- Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Yuyue Chen
- Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Ling Ni
- Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Shuang Zhang
- Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Hong Xia
- Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China
| | - Jingcheng Yang
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, No.1838 North of Guangzhou Road, Guangzhou, 510515, People's Republic of China.
| | - Xiangyang Ma
- The First School of Clinical Medicine, Southern Medical University, No.1838 North of Guangzhou Road, Guangzhou, 510515, People's Republic of China. .,Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China.
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Tian Y, Xu N, Yan M, Passias PG, Segreto FA, Wang S. Atlantoaxial dislocation with congenital "sandwich fusion" in the craniovertebral junction: a retrospective case series of 70 patients. BMC Musculoskelet Disord 2020; 21:821. [PMID: 33287792 PMCID: PMC7722328 DOI: 10.1186/s12891-020-03852-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 12/01/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In the setting of congenital C1 occipitalization and C2-3 fusion, significant strain is placed on the atlantoaxial joint. Vertebral fusion both above and below the atlantoaxial joint (i.e., a "sandwich") creates substantial instability. We retrospectively report on a case series of "sandwich fusion" atlantoaxial dislocation (AAD), describing the associated clinical characteristics and detailing surgical treatment. To the best of our knowledge, the present study is the largest investigation to date of this congenital subgroup of AAD. METHODS Seventy consecutive patients with sandwich fusion AAD, from one senior surgeon, were retrospectively reviewed. The clinical features and the surgical treatment results were assessed using descriptive statistics. No funding sources or potential conflict of interest-associated biases exist. RESULTS The mean patient age was 42.2 years (range: 5-77 years); 36 patients were male, and 34 were female. Fifty-eight patients (82.9%) had myelopathy, with Japanese Orthopaedic Association (JOA) scores ranging 4-16 (mean: 12.9). Cranial neuropathy was involved in 10 cases (14.3%). The most common presentation age group was 31 to 40 years (24 cases, 34.3%). Radiological findings revealed brainstem and/or cervical-medullar compression (58 cases, 82.9%), syringomyelia (16 cases, 22.9%), Chiari malformation (12 cases, 17.1%), cervical spinal stenosis (10 cases, 14.3%), high scapula deformity (1 case, 1.4%), os odontoideum (1 case, 1.4%), and dysplasia of the atlas (1 case, 1.4%). Computed tomography angiography was performed in 27 cases, and vertebral artery (VA) anomalies were identified in 14 cases (51.9%). All 70 patients underwent surgical treatment, without spinal cord or VA injury. Four patients (5.7%) suffered complications, including 1 wound infection, 1 screw loosening, and 2 cases of bulbar paralysis. In the 58 patients with myelopathy, the mean JOA score increased from 12.9 to 14.5. The average follow-up time was 50.5 months (range: 24-120 months). All 70 cases achieved solid atlantoaxial fusion at the final follow-up. CONCLUSIONS Sandwich fusion AAD, a unique subgroup of AAD, has distinctive clinical features and associated malformations such as cervical-medullar compression, syringomyelia, and VA anomalies. Surgical treatment of AAD was associated with myelopathy improvement and minimal complication occurrence.
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Affiliation(s)
- Yinglun Tian
- Department of Orthopaedics, Peking University Third Hospital, No 49 North Garden Street, HaiDian District, Beijing, 100191, People's Republic of China
| | - Nanfang Xu
- Department of Orthopaedics, Peking University Third Hospital, No 49 North Garden Street, HaiDian District, Beijing, 100191, People's Republic of China
| | - Ming Yan
- Department of Orthopaedics, Peking University Third Hospital, No 49 North Garden Street, HaiDian District, Beijing, 100191, People's Republic of China
| | - Peter G Passias
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Frank A Segreto
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Shenglin Wang
- Department of Orthopaedics, Peking University Third Hospital, No 49 North Garden Street, HaiDian District, Beijing, 100191, People's Republic of China.
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Sai Kiran NA, Vidyasagar K, Sivaraju L, Raj V, Aryan S, Thakar S, Mohan D, Hegde AS. Outcome of Surgery for Congenital Craniovertebral Junction Anomalies with Atlantoaxial Dislocation/Basilar Invagination: A Retrospective Study of 94 Patients. World Neurosurg 2020; 146:e313-e322. [PMID: 33096283 DOI: 10.1016/j.wneu.2020.10.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the results of surgery for congenital craniovertebral junction (CVJ) anomalies with atlantoaxial dislocation (AAD)/basilar invagination (BI) and compare the results of transoral odontoidectomy and posterior fusion (TOO+PF) with only posterior fusion (PF) in patients with irreducible AAD/BI. METHODS AND RESULTS All 94 patients with congenital CVJ anomalies with AAD/BI operated on during the 3-year study period (June 2013-May 2016) were included. Of these patients, 55 had irreducible AAD/BI and the remaining 39 had reducible AAD/BI. TOO+PF was restricted to patients (34/94; 36.2%) with irreducible AAD/BI when reduction and realignment by intraoperative C1-C2 facet joint manipulation were considered technically difficult and risky. The remaining patients with irreducible AAD/BI and all the patients with reducible AAD/BI (60/94; 63.8%) were managed with only posterior fusion. Poor preoperative Nurick grade, preoperative dyspnea/lower cranial nerve deficits, and syringomyelia were associated with significantly higher incidence of postoperative pulmonary complications. Follow-up ≥3 months (final follow-up) was available for 87 patients. Good outcome (Nurick grade 0-3) at final follow-up was noted in 90% (45/50) of the patients with irreducible AAD/BI and 91.9% (34/37) of the patients with reducible AAD/BI. Preoperative poor Nurick grade (4-5) was the only factor associated with poor outcome. No significant difference in perioperative complications, outcome, and fusion was noted between patients who underwent TOO+PF or only PF for irreducible AAD/BI. CONCLUSIONS Many of the patients with congenital AAD/BI showed remarkable recovery after surgery. Preoperative poor Nurick grade (4-5) is associated with poor outcome. TOO+PF is a safe alternative treatment option for irreducible AAD/BI when only PF techniques are technically difficult/risky.
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Affiliation(s)
- Narayanam Anantha Sai Kiran
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India
| | - Kanneganti Vidyasagar
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India.
| | - Laxminadh Sivaraju
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India
| | - Vivek Raj
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India
| | - Saritha Aryan
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India
| | - Sumit Thakar
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India
| | - Dilip Mohan
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India
| | - Alangar S Hegde
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India
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Guan J, Jian F, Yao Q, Yuan C, Zhang C, Ma L, Liu Z, Duan W, Wang X, Bo X, Chen Z. Quantitative Reduction of Basilar Invagination With Atlantoaxial Dislocation by a Posterior Approach. Neurospine 2020; 17:574-584. [PMID: 33022162 PMCID: PMC7538363 DOI: 10.14245/ns.2040496.248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 09/07/2020] [Indexed: 11/19/2022] Open
Abstract
Objective This study evaluated the feasibility and efficacy of quantitative reduction and fixation to treat basilar invagination (BI) with atlantoaxial dislocation (AAD).
Methods Posterior occipitocervical angle (POCA), occiput–C2 angle (Oc–C2A), clivusaxial angle (CAA), and C2–7 angle (C2–7A) were considered for quantitative reduction. Twelve patients with BI complicated with AAD received posterior interarticular release and individualized cage implantation to restore vertical dislocation. The POCA was adjusted using cantilever technology to further reduce the horizontal dislocation and adjust lower cervical vertebral angle. All patients received a radiological follow-up for ≥12 months. Improvements in spinal cord function were evaluated using Japanese Orthopedic Association (JOA) score.
Results All the patients received successful quantitative reduction for BI-AAD, and bony fusion was achieved without spinal cord injury after surgery for 12 months. The JOA score was improved significantly to 15.2 ± 0.9 twelve months after surgery (p < 0.01). Radiological follow-up revealed that individualized cage and POCA play vital roles in quantitative
correction: (1) distance of the dens above McRae’s line and atlantodens interval were restored to normal level, respectively; (2) changes in Oc–C2 angle (ΔOc–C2A), C2–7 angle (ΔC2–7A), clivus-axial angle (ΔCAA), and POCA (ΔPOCA) were all caused by changes in axis tilt. Based on the changes of radiological parameter we deduced the formula for quantitative reduction by linear regression analysis: -ΔPOCA = ΔOc–C2A = -ΔC2–7A = ΔCAA. Conclusion Quantitative posterior reduction by individualized cage and adjusting ΔPOCA is feasible for treating BI with AAD.
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Affiliation(s)
- Jian Guan
- Division of Spine, Department of Neurosurgery, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fengzeng Jian
- Division of Spine, Department of Neurosurgery, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qingyu Yao
- Division of Spine, Department of Neurosurgery, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chenghua Yuan
- Division of Spine, Department of Neurosurgery, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Can Zhang
- Division of Spine, Department of Neurosurgery, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Longbing Ma
- Division of Spine, Department of Neurosurgery, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhenlei Liu
- Division of Spine, Department of Neurosurgery, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wanru Duan
- Division of Spine, Department of Neurosurgery, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xingwen Wang
- Division of Spine, Department of Neurosurgery, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xuefeng Bo
- School of Biomedical Engineering, Capital Medical University, Beijing, China.,BeijingKey Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Zan Chen
- Division of Spine, Department of Neurosurgery, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, Beijing, China
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Govindasamy R, Preethish-Kumar V, Gopal S, Rudrappa S. Is Transoral Surgery Still a Relevant Procedure in Atlantoaxial Instability? Int J Spine Surg 2020; 14:657-664. [PMID: 33077434 PMCID: PMC7671436 DOI: 10.14444/7096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The treatment of atlantoaxial instability (AAI) involves stable fixation and fusion with adequate decompression of spinal cord. After the advent of the Goel posterior joint manipulation technique, most of the once irreducible atlantoaxial dislocations (AAD) could be reduced and the need for transoral odontoidectomy became almost nil. Here we tried to iterate the indications of anterior transoral odontoid surgery for AAI in the current scenario. METHODS A retrospective study compiling the clinical, radiological, and surgical characteristics of 6 cases (5 scenarios). These patients underwent anterior transoral surgery alone or in combination with a posterior approach. RESULTS Two patients had a well-formed occipito-cervical fusion mass, with a displaced odontoid and unreduced C1-C2 joint causing cervical myelopathy. A middle-aged woman presented with unreduced AAD following failed C1-C2 joint distraction technique. A displaced dystopic os odontoideum ossicle was found in an adolescent boy, prohibiting the reduction of AAD. A young man had displacement of the fractured odontoid segment with intact transverse alar ligament and C1-C2 joint complex. One patient had a rare scenario of abnormal orientation of the C1-C2 joint. All 6 patients were successfully treated with adequate spinal cord decompression achieved by the anterior transoral route and stabilization by either the anterior approach itself or in combination with posterior surgery. All had significantly better postoperative outcomes except for 1 patient who expired due to poor respiratory reserve. CONCLUSION We tried to emphasize the indications for using transoral anterior odontoid surgery over the posterior approach in the management of AAI. This will prevent the surgical technique of anterior odontoidectomy from becoming an obsolete procedure in the current practice.
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Affiliation(s)
- Ramachandran Govindasamy
- Institute of Neurosciences, Sakra World Hospital, Bellandur, Bangalore, India
- Department of Spine Surgery, Sakra World Hospital, Bellandur, Bangalore, India
| | | | - Swaroop Gopal
- Institute of Neurosciences, Sakra World Hospital, Bellandur, Bangalore, India
| | - Satish Rudrappa
- Institute of Neurosciences, Sakra World Hospital, Bellandur, Bangalore, India
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Rathod TN, Marathe NA, Sathe AH, Mohanty SS, Mallepally AR. Anterior Distraction and Reduction with Posterior Stabilization for Basilar Invagination: A Novel Technique. World Neurosurg 2020; 145:19-24. [PMID: 32891849 DOI: 10.1016/j.wneu.2020.08.220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Introduction of a posterior spacer for atlantoaxial joint distraction followed by posterior stabilization is a commonly performed procedure for irreducible atlantoaxial dislocation. We present a unique case in which posterior distraction was associated with increased risk of injury to the vertebral artery (VA) owing to its anomalous course, and hence a novel anterior distraction technique was used. CASE DESCRIPTION A 45-year-old woman presented with severe neck pain for 1 month with gait imbalance and history of occipital headache for 1 year. Clinical examination revealed upper motor neuron-type findings. Hoffmann sign was positive bilaterally. Clinically, the patient had Nurick grade 4 cervical myelopathy. Magnetic resonance imaging showed basilar invagination along with Arnold-Chiari malformation and syrinx formation at C3-C4 vertebral levels. CT angiography revealed anomalous VAs directly overlying the atlanto-occipital joint. Owing to the anomalous route of the VA and unfavorable slope of facet joints, a 2-step anterior reduction followed by posterior stabilization surgery was planned. We achieved complete reduction using a 10-mm titanium cage inserted via a retropharyngeal approach. Following anterior reduction, instrumented in situ occipitocervical fusion was performed using a plate and screw construct. At 2-year follow-up, the patient is ambulating independently without gait imbalance and with successful radiologic fusion. CONCLUSIONS The craniovertebral junction has a unique pathoanatomy, and the course of the vertebral artery is variable. Appropriate investigations, including computed tomography angiography, with adequate surgical planning will provide a desirable long-term outcome. Our novel technique has the potential to add a new dimension to the management of irreducible atlantoaxial dislocation.
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Affiliation(s)
- Tushar N Rathod
- Department of Orthopaedics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Nandan A Marathe
- Department of Orthopaedics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India.
| | - Ashwin H Sathe
- Department of Orthopaedics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
| | - Shubhranshu S Mohanty
- Department of Orthopaedics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, India
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Ifthekar S, Ahuja K, Mittal S, Sarkar B, Deep G, Thomas W, Kandwal P. Management of Neglected Upper Cervical Spine Injuries. Indian J Orthop 2020; 55:673-679. [PMID: 33995872 PMCID: PMC8081783 DOI: 10.1007/s43465-020-00227-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/06/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Injuries involving upper cervical spine are serious and fatal injuries which are associated with alteration of normal occipital-cervical anatomy. These injuries may result in permanent neurologic deficits or neck deformity if not treated in a timely and appropriate manner. OBJECTIVE To evaluate the outcomes of neglected upper cervical spine injuries treated by various methods. STUDY DESIGN Retrospective study. MATERIALS AND METHODS Twelve patients attending ER or OPD with a history of neck trauma and who were diagnosed with fractures and fracture dislocations C1 and C2 were included in the study. Fresh injuries sustained within a week were excluded from study. The outcomes were measured in terms of improvement in VAS, ODI Scores and correction of the neck deformity. Surgical parameters like duration of surgery and blood loss were also observed. RESULTS Eleven males and one female. The mean age was 40.9 ± 16.9 (07-67 years). Eleven patients underwent posterior instrumentation, while one patient was treated anteriorly. The mean delay in presentation was 28 ± 8.67 days (15-42 days). The mean duration of surgery was 188.3 ± 34.35 min (120-240 min), average blood loss was 350 ± 111.8 ml (150-600 ml). The mean VAS improved from 8.45 ± 0.89 to 3.9 ± 0.51 (p < 0.05). The mean ODI Pre-operatively was 88.45 ± 5.89 which improved to 31.9 ± 4.01 (p < 0.05). The neck deformity/torticollis was corrected in all the patients. CONCLUSIONS Neglected upper cervical spine injuries are difficult to treat and a posterior approach is helpful in reducing the subluxations indirectly and to obtain a posterior fusion.
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Affiliation(s)
- Syed Ifthekar
- Department of Orthopaedics, AIIMS Rishikesh, Rishikesh, Uttarakhand 249203 India
| | - Kaustubh Ahuja
- Department of Orthopaedics, AIIMS Rishikesh, Rishikesh, Uttarakhand 249203 India
| | - Samarth Mittal
- Department of Orthopaedics, AIIMS Rishikesh, Rishikesh, Uttarakhand 249203 India
| | - Bhaskar Sarkar
- Department of Trauma and Emergency, AIIMS Rishikesh, Rishikesh, 249203 Uttarakhand India
| | - Gagan Deep
- Department of Orthopaedics, AIIMS Rishikesh, Rishikesh, Uttarakhand 249203 India
| | - Watson Thomas
- Department of Orthopaedics, AIIMS Rishikesh, Rishikesh, Uttarakhand 249203 India
| | - Pankaj Kandwal
- Department of Orthopaedics, AIIMS Rishikesh, Rishikesh, Uttarakhand 249203 India
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Zhang Y, Ai F, Yin Q, Xia H, Wu Z, Ma X, Wang J. [An observation on risk of infection in treatment of craniovertebral junction disorders by transoral approach operation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:769-774. [PMID: 32538570 DOI: 10.7507/1002-1892.201911006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To study the changes of bacterial flora after a series of preoperative oral disinfection and the postoperative recovery of patients with craniovertebral junction disorders who were treated with transoral approach operations. And to provide a theoretical basis for the prevention of postoperative complications such as infection. Methods The clinical data of 20 cases with craniovertebral junction disorders and treated with transoral approach operations between October 2009 and May 2010 were analyzed. There were 8 males and 12 females, aged 2-66 years (median, 34.5 years). According to the classification of American Spinal Injury Association (ASIA),there were 4 cases of grade B, 8 of grade C, 6 of grade D, and 2 of grade E. The Japanese Orthopedic Association (JOA) score was 10.3±3.0. The mucosa samples of the posterior pharyngeal wall were sent for bacteria culture. These samples were collected by sterile cotton swabs at four crucial points including 3 days before operation/before gargling (T1), 3 days after continuous gargling by chlorhexidine acetate/after anesthesia intubation on the day of operation (T2), after intraoperative cleaning and washing of the mouth (T3), and after intraoperative iodophor immersion for 5-10 minutes (T4). The microflora was stained by means of smear and further counted after an investigation by microscope. The ASIA classification and the JOA scores were applied to evaluate the postoperative nerve function of the patients. A regular reexamination of cervical vertebra with X-ray film, CT, and MRI was conducted after operation to evaluate the reduction of atlantoaxial dislocation, internal fixation position, bone graft fusion, inflammatory lesion, and tumor resection in the craniovertebral junction. Results After a series of oral disinfection, the mucosa of the posterior pharyngeal wall of all the patients was in a sterile state, which was considered as type Ⅰ incision. All these 20 patients were treated with successful operations, without any intraoperative injury in vertebral artery and spinal cord, or any postoperative complications such as plate loosening, incision infection, or intracranial infection. All the patients were followed up 3-23 months, with an average of 5.15 months. The symptoms such as neck pain, limb numbness and weakness, neural symptoms, etc. were improved to different degrees after operation. The JOA score was improved to 13.4±1.9 at 3 months after operation, showing significant difference when compared with preoperative score ( t=8.677, P=0.000); and the atlantoaxial joints had been fused. At last follow-up, the ASIA grades were improved when compared with those before operation. Conclusion It is safe and effective to cut the posterior pharyngeal muscle layer and implant internal fixation by means of transoral approach in the treatment of craniovertebral junction disorders.
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Affiliation(s)
- Yu Zhang
- Department of Spinal Surgery, General Hospital of Southern Theatre Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
| | - Fuzhi Ai
- Department of Spinal Surgery, General Hospital of Southern Theatre Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
| | - Qingshui Yin
- Department of Spinal Surgery, General Hospital of Southern Theatre Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
| | - Hong Xia
- Department of Spinal Surgery, General Hospital of Southern Theatre Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
| | - Zenghui Wu
- Department of Spinal Surgery, General Hospital of Southern Theatre Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
| | - Xiangyang Ma
- Department of Spinal Surgery, General Hospital of Southern Theatre Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
| | - Jianhua Wang
- Department of Spinal Surgery, General Hospital of Southern Theatre Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
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Srivastava SK, Raj A, Bhosale S, Purohit S, Marathe N, Gaddikeri M. Management of congenital craniovertebral anomalies: a single-centre experience of 71 cases by an algorithmic approach. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:2758-2768. [PMID: 32676703 DOI: 10.1007/s00586-020-06522-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/01/2020] [Accepted: 06/24/2020] [Indexed: 10/23/2022]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE Congenital craniovertebral (CV) anomalies include a wide variety of conditions involving basilar invagination (BI), atlantoaxial dislocation (AAD), bony congenital anomalies and Chiari malformation. The management of these disorders is more surgeon dependent rather than based on clear guidelines. This study aims to provide a step-by-step algorithmic approach to the management of congenital CV anomalies to achieve good CV alignment, neural recovery and long lasting stability. MATERIALS The study retrospectively analyses 71 patients of congenital CV anomalies treated by our algorithmic approach. Clinical assessment was done with the help of Nurick's grading pre- and post-operatively. Radiological outcome was assessed by plain radiographs, and computed tomographic scan was done at 12-month follow-up. RESULTS Mean age at presentation was 17.9 years (6-41 years). Mean Nurick score pre-operatively was 3.8 which was reduced to 1.3 at a mean follow-up of 13.6 months. Sixty-one patients had type I BI, 6 had type II BI, and 4 patients had os odontoideum. Most common symptom at presentation was weakness in limbs, neck pain and difficulty in walking. Patients of isolated AAD with os odontoideum required posterior atlantoaxial fixation and fusion only. Thirty-two patients of type I BI and 4 patients of type II BI required anterior release procedures prior to occipitocervical instrumentation. Bony fusion was achieved in 96% (68) cases with the help of autologous bone grafting. Three patients of occipitocervical fusion developed pseudoarthrosis. CONCLUSION Our retrospective analysis demonstrates that the algorithm is effective in ensuring long lasting results in all types congenital CV anomalies.
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Affiliation(s)
- Sudhir K Srivastava
- Department of Orthopaedics, Seth G.S. Medical College and K.E.M. Hospital, 6th Floor MSB, Parel, Mumbai, 400 012, India
| | - Aditya Raj
- Department of Orthopaedics, Seth G.S. Medical College and K.E.M. Hospital, 6th Floor MSB, Parel, Mumbai, 400 012, India.
| | - Sunil Bhosale
- Department of Orthopaedics, Seth G.S. Medical College and K.E.M. Hospital, 6th Floor MSB, Parel, Mumbai, 400 012, India
| | - Shaligram Purohit
- Department of Orthopaedics, Seth G.S. Medical College and K.E.M. Hospital, 6th Floor MSB, Parel, Mumbai, 400 012, India
| | - Nandan Marathe
- Department of Orthopaedics, Seth G.S. Medical College and K.E.M. Hospital, 6th Floor MSB, Parel, Mumbai, 400 012, India
| | - Manojkumar Gaddikeri
- Department of Orthopaedics, Seth G.S. Medical College and K.E.M. Hospital, 6th Floor MSB, Parel, Mumbai, 400 012, India
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Ren X, Gao F, Li S, Yang J, Xi Y. Treatment of irreducible atlantoaxial dislocation using one-stage retropharyngeal release and posterior reduction. J Orthop Surg (Hong Kong) 2020; 27:2309499019870465. [PMID: 31451023 DOI: 10.1177/2309499019870465] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Irreducible atlantoaxial dislocation (IAAD) has been challenging for spine surgeons. Various methods have been used to treat IAAD, but no consensus has been reached. This study aimed to retrospectively analyze the efficacy of anterior submandibular retropharyngeal release and posterior reduction and fixation for IAAD. METHODS From March 2007 to May 2015, 13 patients diagnosed with IAAD underwent anterior submandibular retropharyngeal release and sequential posterior reduction and fixation. The operation time, blood loss, postoperative complications, and Japanese Orthopaedic Association (JOA) scores were retrospectively recorded. RESULTS The surgeries were accomplished successfully. The mean operative time was about 3.8 h. The mean estimated blood loss was about 130 mL. The patients experienced postoperative pharyngeal pain. Only one patient had a vague voice and increased oral discharge postoperatively. At the final follow-up, JOA scores had significantly increased (p < 0.05), and all the patients had solid bony fusion. CONCLUSION The present study reinforces the efficacy and safety of anterior submandibular retropharyngeal release and posterior reduction and fixation for IAAD. It can achieve satisfactory clinical outcomes and is safe for experienced spine surgeons.
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Affiliation(s)
- Xianfeng Ren
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Feng Gao
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Siyuan Li
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Jiankun Yang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Yongming Xi
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
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Dong C, Yang F, Wei H, Tan M. Anterior release without odontoidectomy for irreducible atlantoaxial dislocation: transoral or endoscopic transnasal? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:507-516. [PMID: 32654012 DOI: 10.1007/s00586-020-06527-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/30/2020] [Accepted: 07/01/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare transoral and endoscopic transnasal anterior release without odontoidectomy and posterior reduction and fixation to treat irreducible atlantoaxial dislocation (IAAD). METHODS From June 2006 to January 2017, 35 consecutive patients with IAAD underwent transoral (Tr-Oral group) or endoscopic transnasal (Tr-Nasal group) release and posterior fixation and fusion in our department. Clinical neurological recovery (Japanese Orthopedic Association (JOA) score) and radiological reduction parameters including atlantodontoid interval (ADI), space available for the cord (SAC) and cervicomedullary angle (CMA) were analyzed and compared. The operation duration, blood loss, length of intensive care unit (ICU)/hospital stay and complications were recorded. RESULTS All 35 patients (18 and 17 patients in the Tr-Oral and Tr-Nasal groups, respectively) were followed up for a mean of 36.4 months (range, 21-60 months). All patients achieved excellent anatomical reduction and clinical neurological recovery, with no significant differences between the two groups. The JOA score, ADI, SAC and CMA were not significantly different between the two groups at various postoperative points. Although the Tr-Oral group had shorter operation time and less blood loss than the Tr-Nasal group, the Tr-Nasal group tended to have a significantly shorter hospital/ICU stay, earlier extubation and earlier oral intake than the Tr-Oral group. CONCLUSION The transoral and endoscopic transnasal approaches can achieve equivalent release and reduction effects when treating IAAD. Compared to the transoral approach, the endoscopic transnasal route is less invasive with earlier extubation and oral intake, shorter hospital/ICU stays and lower medical costs, which is conducive to enhanced recovery after surgery.
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Affiliation(s)
- Chunke Dong
- Beijing University of Chinese Medicine, 11 North Third Ring Road East, Chaoyang District, Beijing, 100029, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Feng Yang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Hongyu Wei
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Mingsheng Tan
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
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Zhang Y, Li C, Li L, Sun Y, Li Z, Mei Y, Feng X. Design a novel integrated screw for minimally invasive atlantoaxial anterior transarticular screw fixation: a finite element analysis. J Orthop Surg Res 2020; 15:244. [PMID: 32631369 PMCID: PMC7339419 DOI: 10.1186/s13018-020-01764-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/26/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To design a new type of screw for minimally invasive atlantoaxial anterior transarticular screw (AATS) fixation with a diameter that is significantly thicker than that of traditional screws, threaded structures at both ends, and a porous metal structure in the middle. The use of a porous metal structure can effectively promote bone fusion and compensate for the disadvantages of traditional AATSs in terms of insufficient fixation strength and difficulty of bone fusion. The biomechanical stability of this screw was verified through finite element analysis. This instrument may provide a new surgical option for the treatment of atlantoaxial disorders. METHODS According to the surgical procedure, the new type of AATS was placed in a three-dimensional atlantoaxial model to determine the setting of relevant parameters such as the diameter, length, and thread to porous metal ratio of the structure. According to the results of measurement, the feasibility and safety of the new AATS were verified, and a representative finite element model of the upper cervical vertebrae was chosen to establish, and the validity of the model was verified. Then, finite element-based biomechanical analysis was performed using three models, i.e., atlantoaxial posterior pedicle screw fixation, traditional atlantoaxial AATS fixation, and atlantoaxial AATS fixation with the new type of screw, and the biomechanical effectiveness of the novel AATS was verified. RESULTS By measuring the atlantoaxial parameters, the atlantoaxial CT data of the representative 30-year-old normal adult male were selected to create a personalized 3D printing AATS screw. In this case, the design parameters of the new screw were determined as follows: diameter, 6 mm; length of the head thread structure, 10 mm; length of the middle porous metal structure, 8 mm (a middle porous structure containing an annular cylinder ); length of the tail thread structure, 8 mm; and total length, 26 mm. Applying the same load conditions to the atlantoaxial complex along different directions in the established finite element models of the three types of atlantoaxial fusion modes, the immediate stability of the new AATS is similar with Atlantoaxial posterior pedicle screw fixation.They are both superior to traditional atlantoaxial anterior screw fixation.The maximum local stress on the screw head in the atlantoaxial anterior surgery was less than those of traditional atlantoaxial anterior surgery. CONCLUSIONS By measuring relevant atlantoaxial data, we found that screws with a larger diameter can be used in AATS surgery, and the new AATS can make full use of the atlantoaxial lateral mass space and increase the stability of fixation. The finite element analysis and verification revealed that the biomechanical stability of the new AATS was superior to the AATS used in traditional atlantoaxial AATS fixation. The porous metal structure of the new AATS may promote fusion between atlantoaxial joints and allow more effective bone fusion in the minimally invasive anterior approach surgery.
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Affiliation(s)
- Yingkai Zhang
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Sanhao Road 36, Shenyang City, 110001, Liaoning Province, People's Republic of China
| | - Cheng Li
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Sanhao Road 36, Shenyang City, 110001, Liaoning Province, People's Republic of China
| | - Lei Li
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Sanhao Road 36, Shenyang City, 110001, Liaoning Province, People's Republic of China.
| | - Yanyan Sun
- Shandong Weigao Orthopaedic Device co., Ltd., Weihai, 264300, People's Republic of China
| | - Zeqing Li
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Sanhao Road 36, Shenyang City, 110001, Liaoning Province, People's Republic of China
| | - Yunli Mei
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Sanhao Road 36, Shenyang City, 110001, Liaoning Province, People's Republic of China
| | - Xinyuan Feng
- Department of Orthopaedic Surgery, Shengjing Hospital of China Medical University, Sanhao Road 36, Shenyang City, 110001, Liaoning Province, People's Republic of China
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Duan W, Chou D, Jian F, Chen Z. Posterior intra-articular distraction with cage placement to treat congenital atlantoaxial dislocation associated with basilar invagination. NEUROSURGICAL FOCUS: VIDEO 2020; 3:V2. [PMID: 36285121 PMCID: PMC9542379 DOI: 10.3171/2020.3.focusvid.191001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 03/31/2020] [Indexed: 06/16/2023]
Abstract
Congenital atlantoaxial dislocation (AAD) associated with basilar invagination (BI) is a complex congenital malalignment at the craniovertebral junction. The olisthesis, atlantoaxial facet joint arthropathy, and the contraction of the anterior soft tissue make the treatment challenging. Our video demonstrates the surgical technique for posterior intra-articular distraction with cage placement to treat congenital atlantoaxial dislocation associated with basilar invagination. The video can be found here: https://youtu.be/7EQqW96HhN8.
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Affiliation(s)
- Wanru Duan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
| | - Dean Chou
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Fengzeng Jian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
| | - Zan Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; and
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Du YQ, Qiao GY, Yin YH, Li T, Yu XG. Posterior atlantoaxial facet joint reduction, fixation and fusion as revision surgery for failed suboccipital decompression in patients with basilar invagination and atlantoaxial dislocation: Operative nuances, challenges and outcomes. Clin Neurol Neurosurg 2020; 194:105793. [PMID: 32283470 DOI: 10.1016/j.clineuro.2020.105793] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 01/21/2020] [Accepted: 03/16/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report the technical nuances and clinical outcomes of posterior atlantoaxial facet joint reduction, fixation and fusion (AFRF) technique as a revision procedure for BI and AAD patients with failed suboccipital decompression and large occipital bone defect. PATIENTS AND METHODS We reviewed 32 patients with BI and AAD who were misdiagnosed as a simple Chiari malformation and received a suboccipital decompression surgery before admission. All patients underwent AFRF as a revision surgery. The separating, fusing, opacifying and false-coloring-volume rendering (SFOF-VR) technique was used to identify the course of the VA. Clinical and radiological outcomes were assessed after revision surgeries. RESULTS Clinical symptoms improved in all patients. The postoperative atlantodens interval, Wackenheim line and clivus-canal angle significantly improved (all P < 0.01). Intraoperative dural tear and cerebrospinal fluid leakage occurred in 3 patients and were managed by suture repair and lumbar drain. Abnormal VA was identified in 7 patients and no VA injury occurred with the aid of SFOF-VR technique. The average follow-up was 19.1 months and atlantoaxial bone fusion was confirmed in 31 patients. CONCLUSION For BI and AAD patients with failed suboccipital decompression, revision surgery is challenging. Occipitocervical fixation and posterior midline bone grafting are rather difficult due to the large occipital bone defect. The current study demonstrated that the posterior AFRF is a simple, safe and highly effective technique in revision surgery for such cases. For VA variations, the SFOF-VR technique is an effective tool to delineate the course VA.
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Affiliation(s)
- Yue-Qi Du
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Guang-Yu Qiao
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yi-Heng Yin
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Teng Li
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Xin-Guang Yu
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
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BO XUEFENG, WANG WEIDA, CHEN ZAN, LIU ZHICHENG. RESEARCH ON THE STRATEGY OF REDUCTION OPERATION OF BASILAR INVAGINATION COMBINED WITH ATLANTOAXIAL DISLOCATION. J MECH MED BIOL 2020. [DOI: 10.1142/s0219519420500281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The complicated basilar invagination and atlantoaxial dislocation (BI-AAD) can cause a variety of neurological symptoms. Active treatment should be given. The main method of surgical treatment is to relieve the compression of the ventral bone of the brain stem and to fix the unstable spinal segments for fusion. At present, more surgical methods choose modified posterior cervical reduction and internal fixation fusion. Objective: The clinician has preliminarily designed an internal occipital fixation system capable of restoring both horizontal and vertical AADs, and proposed a new compression and distraction reduction (CDR) technique. The feasibility and effectiveness of posterior AAD reduction surgery using CDR techniques for different types of patients were studied in this paper. Methods: First, according to the CT scan sequence images of the congenital BI-AAD patient’s cervical vertebra, the software Materialize Mimics 13.1 was imported to reconstruct 3D geometric model of cervical spine (C0-C7). Then the geometric topology model was carried out in Geomagic2012 software, and surrounding soft tissue was established using SpaceClaim 14.0. The 3D finite element model (FEM) of cervical vertebra for congenital BI-AAD patients was obtained by assigning material attributes, setting contacts and mesh in ANSYS 14.0. To simulate the physiological activities of the spine under two conditions of forward flexion and backward extension, preoperative verification was carried out with the maximum displacement parameter. According to the postoperative CT data of the patient, the position and degree of freedom (DOF) of the occipitocervical internal fixation system were determined. The FEM of the occipitocervical internal fixation system was established by dividing unit grid in ANSYS. Using multiple loading step of statics analysis method, the CDR technology of posterior AAD reduction surgery was simulated. When the atlantoaxial horizontal and vertical reductions were satisfactory, the displacement data were obtained and verified using the post-operative data. Results: The cervical spine (C0-C7) FEM of congenital BI-AAD patients was established. For some lateral atlantoaxial articulation abnormal ossification II, we simulated the CDR technique for the AAD reduction surgery and proposed using the vertical traction instead of vertical reduction. Conclusion: This study confirms the feasibility and effectiveness of posterior AAD reduction surgery using CDR techniques and proposes the different reduction optimization scheme for the patients with lateral atlantoaxial articulation abnormal ossification II of congenital BI-AAD. The results of this study provide a biomechanical theoretical basis for improving the reliability of simple posterior reduction surgery and optimizing the surgical treatment of BI-AAD.
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Affiliation(s)
- XUEFENG BO
- School of Biomedical Engineering, Capital Medical University, Beijing 100069, P. R. China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing 100069, P. R. China
| | - WEIDA WANG
- Anshi Asia Pacific Technology Co., Ltd., Beijing Branch, Beijing 100025, P. R. China
| | - ZAN CHEN
- Xuanwu Hospital, Capital Medical University, Beijing 100053, P. R. China
| | - ZHICHENG LIU
- School of Biomedical Engineering, Capital Medical University, Beijing 100069, P. R. China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing 100069, P. R. China
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Wong TS, Abdul Rashid ML, Hasan MS, Chiu CK, Chan CYW, Kwan MK. C1-C2 fusion with absence of C1 posterior arch and presence of C2 high-riding vertebral artery: Is it possible? J Orthop Surg (Hong Kong) 2020; 27:2309499019840763. [PMID: 30955474 DOI: 10.1177/2309499019840763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The presence of anatomical anomalies such as absence of C1 posterior arch and presence of C2 high-riding vertebral artery may not allow a conventional C1-C2 fusion, and this patient will require occipitocervical fusion. A 62-year-old lady presented with cervical myelopathy. CT scan demonstrated an os odontoideum with C1-C2 dislocation. The posterior arch of atlas on right C1 vertebra was absent, and there was high-riding vertebral artery on left C2. MRI revealed severe cord compression with cord oedema. The chronic atlantoaxial dislocation was reduced successfully with skeletal traction. Hybrid C1-C2 fusion augmented with autogenous local bone graft with corticocancellous iliac crest bone graft was performed to avoid an unnecessary occipitocervical fusion. She was stable throughout surgery and discharged 6 days later. CT scan 6 months post-operation showed a solid posterior fusion mass. Hybrid C1-C2 fusion can be performed to avoid occipitocervical fusion despite presence of abnormal anatomy at C1 and C2 vertebrae.
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Affiliation(s)
- Tat Seng Wong
- 1 Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Muhammad Lutfi Abdul Rashid
- 1 Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Shahnaz Hasan
- 2 Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kidd Chiu
- 1 Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- 1 Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- 1 Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Guo J, Lu W, Ji X, Ren X, Tang X, Zhao Z, Hu H, Song T, Du Y, Li J, Shao C, Xu T, Xi Y. Surgical treatment of atlantoaxial subluxation by intraoperative skull traction and C1-C2 fixation. BMC Musculoskelet Disord 2020; 21:239. [PMID: 32290830 PMCID: PMC7158009 DOI: 10.1186/s12891-020-03273-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/07/2020] [Indexed: 02/02/2023] Open
Abstract
Background Atlantoaxial subluxation (AAS) is a not rare abnormality between the atlas (C1) and axis (C2). For AAS patients with persistent neck pain and neurologic symptoms, surgical intervention is a good choice. Nevertheless, there were still few reports about the use of intraoperative skull traction and different fixation methods in treatment of AAS. Methods From January 2012 to December 2018, a total of 86 cases were admitted to our hospital and diagnosed as AAS. All the patients received atlantoaxial reduction with the help of intraoperative skull traction and C1-C2 fixation. Clinical and radiological parameters were collected through chart review. Results There were 86 cases included in this study. The mean operative time was 153.9 ± 73.9 min, and the mean amount of intraoperative blood loss was 219.1 ± 195.6 ml. 81 patients underwent posterior reduction, internal fixation and fusion. 5 patients underwent anterior release, followed by posterior internal fixation and fusion. 82 patients got satisfactory postoperative outcomes while complications occurred in 4 patients. Significant neurologic improvement was observed in these patients. Bone fusion was achieved on the midline sagittal reconstructed CT images at the latest follow-up in all these patients except 1 case. All the patients were followed up for 34.84 ± 15.86 months at average (range 12–60 months). The mean ADI value was 7.55 ± 1.67 mm at average preoperatively, and improved to 4.03 ± 1.21 mm postoperatively, and to 4.21 ± 0.99 mm at the latest follow-up. The mean A-A angle was 15.48 ± 9.82 degrees at average preoperatively, and improved to 21.61 ± 10.43 degrees postoperatively, and to 19.73 ± 8.13 degrees at the latest follow-up. The mean A-A height was 35.61 ± 7.66 mm at average preoperatively, and improved to 40.08 ± 8.5 mm postoperatively, and to 38.83 ± 6.97 mm at the latest follow-up. There were complications in 4 patients, including pedicle misplacement, pedicle screw fracture, infection and one death. Conclusion Intraoperative skull traction can effectively facilitate the surgical procedures for ASS caused by different etiologies. Further research will be needed to investigate the safety and effectiveness of this method in the future.
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Affiliation(s)
- Jianwei Guo
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, Shandong Province, People's Republic of China
| | - Wencan Lu
- Department of Spine Surgery, Shenzhen University General Hospital, Xueyuan AVE 1098, Nanshan District, Shenzhen, Guangdong, People's Republic of China
| | - Xiangli Ji
- Department of Intensive Care Unit, Qilu Hospital of Shandong University (Qingdao), 758 Hefei Road, Qingdao, 266035, Shandong Province, People's Republic of China
| | - Xianfeng Ren
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, Shandong Province, People's Republic of China
| | - Xiaojie Tang
- Department of Orthopedics, Yantai Affiliated Hospital of Binzhou Medical University, 717 Jinbu Street, Muping District, Yantai, 264000, Shandong Province, People's Republic of China
| | - Zheng Zhao
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, Shandong Province, People's Republic of China
| | - Huiqiang Hu
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, Shandong Province, People's Republic of China
| | - Tao Song
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, Shandong Province, People's Republic of China
| | - Yukun Du
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, Shandong Province, People's Republic of China
| | - Jianyi Li
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, Shandong Province, People's Republic of China
| | - Cheng Shao
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, Shandong Province, People's Republic of China
| | - Tongshuai Xu
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, Shandong Province, People's Republic of China
| | - Yongming Xi
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, Shandong Province, People's Republic of China.
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