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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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2
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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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3
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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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González DCN, Ardura Aragón F, Sanjuan JC, Maniega SS, Andrino AL, García Fraile R, Labrador Hernández G, Calabia-Campo J, Caballero-García A, Córdova-Martínez A. C1-C2 Rotatory Subluxation in Adults “A Narrative Review”. Diagnostics (Basel) 2022; 12:diagnostics12071615. [PMID: 35885520 PMCID: PMC9316247 DOI: 10.3390/diagnostics12071615] [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: 06/06/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 11/28/2022] Open
Abstract
The atlantoaxial joint C2 (axis) with the anterior arch of C1 (atlas) allows 50% of cervical lateral rotation. It is responsible for precise and important movements that allow us to perform precise actions, both in normal and working life. Due to low incidence in adults, this condition often goes undiagnosed, or the diagnosis is delayed and the outcome is worse. An early diagnosis and treatment are essential to ensure satisfactory neurological and functional outcomes. The aim of this review is to analyze C1-C2 rotatory subluxation in adults, given its rarity. The time between injury and reduction is key, as it is directly related to prognosis and the severity of the treatment options. Due to low incidence in adults, this condition often goes undiagnosed, or the diagnosis is delayed as a lot of cases are not related to a clear trauma, with a poor prognosis just because of the late diagnosis and the outcome is worse. The correct approach and treatment of atlantoaxial dislocation requires a careful study of the radiological findings to decide the direction and plane of the dislocation, and the search for associated skeletal anomalies.
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Affiliation(s)
- David C. Noriega González
- Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain; (D.C.N.G.); (F.A.A.)
| | - Francisco Ardura Aragón
- Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain; (D.C.N.G.); (F.A.A.)
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (A.L.A.); (R.G.F.); (G.L.H.)
| | - Jesús Crespo Sanjuan
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (A.L.A.); (R.G.F.); (G.L.H.)
| | - Silvia Santiago Maniega
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (A.L.A.); (R.G.F.); (G.L.H.)
| | - Alejandro León Andrino
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (A.L.A.); (R.G.F.); (G.L.H.)
| | - Rubén García Fraile
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (A.L.A.); (R.G.F.); (G.L.H.)
| | - Gregorio Labrador Hernández
- Department of Orthopedic, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain; (J.C.S.); (S.S.M.); (A.L.A.); (R.G.F.); (G.L.H.)
| | - Juan Calabia-Campo
- Department of Radiology, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain;
| | - Alberto Caballero-García
- Department of Anatomy and Radiology, Health Sciences Faculty, GIR: “Physical Exercise and Aging”, University of Valladolid, Campus Universitario “Los Pajaritos”, 42004 Soria, Spain;
| | - Alfredo Córdova-Martínez
- Department of Biochemistry, Molecular Biology and Physiology, Health Sciences Faculty, GIR: “Physical Exercise and Aging”, University of Valladolid, Campus Universitario “Los Pajaritos”, 42004 Soria, Spain
- Correspondence:
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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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Shan J, Zhu MS, Li LT, Peng P, Dai M, Lin LJ, Li JY. An Intraoperative Trajectory-Determined Strategy of Patient-Specific Drill Template for C 2 Transoral Pedicle Insertion in Incomplete Reduction of Atlantoaxial Dislocation: An In Vitro Study. Orthop Surg 2021; 13:1646-1653. [PMID: 34096172 PMCID: PMC8313163 DOI: 10.1111/os.13049] [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: 10/21/2020] [Revised: 03/18/2021] [Accepted: 04/17/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives This study aims to explore a novel intraoperative trajectory‐determined strategy of grouped patient‐specific drill templates (PDTs) for transoral C2 pedicle screw insertion (C2TOPI) for atlantoaxial dislocation (AAD) with incomplete reduction and to evaluate its efficiency and accuracy. Methods Ten cadaveric C2 specimens were scanned by computed tomography (CT) and randomly divided into two groups (the PDT and freehand groups). A novel intraoperative trajectory‐determined strategy of grouped PDTs was created for AAD with incomplete reduction. C2TOPI was performed by use of the PDT technique and the fluoroscopy‐guided freehand technique. After surgery, the screw deviations from the centroid of the cross‐section at the midpoint of the pedicle and screw position grades were assessed in both groups. Results Compared to the freehand group, the PDT group had a significantly shorter surgery time than the freehand group (47.7 vs 61.9 min, P < 0.001). The absolute deviations from the centroids between the preoperative designs and postoperative measurements on the axial plane of the pedicle were 1.19 ± 0.25 mm in the PDT group and 1.82 ± 0.51 mm in the freehand group. On the sagittal plane of the pedicle, the corresponding values were 1.10 ± 0.33 mm in the PDT group and 1.70 ± 0.49 mm in the freehand group. The absolute deviations of the free‐hand group on both the axial and sagittal planes were higher than that of the freehand group (P < 0.05 and P < 0.05, respectively). For the grade of screw insertion position, nine (90%) were observed in type I and one (10%) in type II in the PDT group, whereas five (50%) were in type I, three (30%) were in type II, and two (20%) in type III in the freehand group. Statistical differences could not be found between the groups in terms of the screw positions (P > 0.05). Conclusion The novel intraoperative trajectory‐determined strategy of grouped PDTs can be used as an accurate and feasible method for C2TOPI for AAD with incomplete reduction.
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Affiliation(s)
- Jing Shan
- Department of Orthopaedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Mei-Song Zhu
- Department of Orthopaedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lu-Tao Li
- Department of Joint and Orthopaedics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Peng Peng
- Department of Orthopaedics, TCM-Integrated Hospital of Southern Medical University, Guangzhou, China
| | - Min Dai
- Department of Orthopaedics, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Li-Jun Lin
- Department of Joint and Orthopaedics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jian-Yi Li
- Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.,Nanhai Hospital, Southern Medical University, Foshan, China
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7
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Ma F, Liao Y, Tang Q, Tang C, Luo N, He H, Yang S, Wang Q, Zhong D. Morphometric Analysis of the Lateral Atlantoaxial Joints in Patients with an Old Type II Odontoid Fracture and Atlantoaxial Dislocation: A Study Based on CT Analysis. Spine (Phila Pa 1976) 2021; 46:726-733. [PMID: 33337679 DOI: 10.1097/brs.0000000000003894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
MINI The morphological features of the lateral atlantoaxial joints (LAJs) in patients with old type II odontoid fractures and atlantoaxial dislocation have not been fully analyzed. Our study found the changes in morphological features of the LAJs in some patients, and revealed the causes and consequences of the changes in morphological features of the LAJs.
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Affiliation(s)
- Fei Ma
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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8
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Tu Q, Chen H, Ma XY, Wang JH, Zhang K, Xu JZ, Xia H. Usefulness of a Three-Dimensional-Printed Model in the Treatment of Irreducible Atlantoaxial Dislocation with Transoral Atlantoaxial Reduction Plate. Orthop Surg 2021; 13:799-811. [PMID: 33719205 PMCID: PMC8126926 DOI: 10.1111/os.12961] [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: 08/11/2020] [Revised: 12/28/2020] [Accepted: 01/28/2021] [Indexed: 12/01/2022] Open
Abstract
Objective To evaluate the usefulness of a 3D‐printed model for transoral atlantoaxial reduction plate (TARP) surgery in the treatment of irreducible atlantoaxial dislocation (IAAD). Methods A retrospective review was conducted of 23 patients (13 men, 10 women; mean age 58.17 ± 5.27 years) with IAAD who underwent TARP from January 2015 to July 2017. Patients were divided into a 3D group (12 patients) and a non‐3D group (11 patients). A preoperative simulation process was undertaken for the patients in the 3D group, with preselection of the TARP system using a 3D‐printed 1:1 scale model, while only imaging data was used for the non‐3D group. Complications, clinical outcomes (Japanese Orthopaedic Association [JOA] and visual analogue score [VAS]), and image measurements (atlas–dens interval [ADI], cervicomedullary angle [CMA], and clivus‐canal angle [CCA]) were noted preoperatively and at the last follow up. Results A total of 23 patients with a follow‐up time of 16.26 ± 4.27 months were included in the present study. The surgery duration, intraoperative blood loss, and fluoroscopy times in the 3D group were found to be shorter than those in non‐3D group, with statistical significance. The surgery duration was 3.29 ± 0.45 h in the 3D group and 4.68 ± 0.90 h in the non‐3D group, and the estimated intraoperative blood loss was 131.67 ± 43.03 mL in the 3D group and 185.45 ± 42.28 mL in the non‐3D group. No patients received blood transfusions. The intraoperative fluoroscopy times were 5.67 ± 0.89 in the 3D group and 7.91 ± 1.45 in the non‐3D group. Preoperatively and at last follow up, JOA and VAS scores and ADI, CCA, and CMA were improved significantly within the two groups. However, no statistical difference was observed between the two groups. However, surgical site infection occurred in 1 patient in the 3D group, who underwent an emergency revision operation of the removal of TARP device and posterior occipitocervical fixation; the patient recovered 2 weeks after the surgery. In 2 patients in the traditional group, a mistake occurred in the placement of screws, with no neurological symptoms related to the misplacement. Conclusion Preoperative surgical simulation using a 3D‐printed real‐size model is an intuitive and effective aid for TARP surgery for treating IAAD. The 3D‐printed biomodel precisely replicated patient‐specific anatomy for use in complicated craniovertebral junction surgery. The information was more useful than that available with 3D reconstructed images.
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Affiliation(s)
- Qiang Tu
- Department of Orthopaedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China.,Department of Orthopaedics, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Hu Chen
- Department of Orthopaedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China.,Department of Orthopaedics, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiang-Yang Ma
- Department of Orthopaedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Jian-Hua Wang
- Department of Orthopaedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Kai Zhang
- Department of Orthopaedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Jian-Zhong Xu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Hong Xia
- Department of Orthopaedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, China.,Department of Orthopaedics, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
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Kinematic MRI Analysis of Reducible Atlantoaxial Dislocation for Decompression. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5395071. [PMID: 33381556 PMCID: PMC7755474 DOI: 10.1155/2020/5395071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/13/2020] [Accepted: 10/29/2020] [Indexed: 11/20/2022]
Abstract
Background Many doctors ignored the possibility that there is still a spinal cord compression (SCC) need for decompression after atlantoaxial reduction. Reduction can be achieved on kinematic magnetic resonance imaging (MRI); thus, we want to analyze the role of kinematic MRI in reducible atlantoaxial dislocation and make a preoperative decision whether to perform decompression. Methods 36 patients with atlantoaxial reduction on preoperative kinematic MRI in extension postures were enrolled retrospectively. Grouping was based on the condition of SCC after atlantoaxial reduction preoperatively. Group A: patients with SCC after atlantoaxial reduction on dynamic cervical MRI were treated with C1 laminectomy for decompression and atlantoaxial fixation. Group B: patients with no significant SCC, according to dynamic MRI, underwent only atlantoaxial fixation. Clinical outcomes were evaluated using JOA score for spinal cord function. Radiological outcomes were assessed by measuring spinal cord diameter on MRI. Results The mean follow-up time was 17.1 months. Postoperative JOA score and percentage of SCC in both groups were significantly better than its preoperative score. There were no significant statistical differences in the JOA score at 12 months after surgery and the JOA improvement rate between two groups. All patients in the two groups had a lower percentage of SCC on preoperative extension MRI, compared with neutral MRI. No significant statistical differences in the spinal decompression improvement rate were observed between the two groups. Conclusions Decompression should be performed in patients who still have significant SCC on preoperative kinematic MRI. Kinematic MRI could be used to assess SCC and decide whether to perform decompression preoperatively.
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10
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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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11
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Shen Q, Xia Y, Xu T. Clinical Outcomes of Atlantoaxial Dislocation Combined with Osteoporosis Using Posterior Atlantoaxial Rod, Screw Fixation, and Posterior Interfacet Fusion: A Retrospective Study of 21 Cases. Med Sci Monit 2020; 26:e925187. [PMID: 32909549 PMCID: PMC7504866 DOI: 10.12659/msm.925187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Surgical procedures on atlantoaxial dislocation combined with osteoporosis remain controversial. This study was established to assess the mid-term clinical outcomes of atlantoaxial dislocation combined with osteoporosis using posterior atlantoaxial rod, screw fixation and posterior interfacet fusion. Material/Methods From January 2017 to January 2020, 21 patients (4 males and 17 females) with coexisting atlantoaxial dislocation and osteoporosis who underwent posterior atlantoaxial rod and screw fixation were included in our study with an average age of 64±8.1 years (range, 57–74 years). The subjective and objective symptoms, together with the neurological function of the patients were measured. Radiography and magnetic resonance imaging (MRI) were performed, Japanese Orthopaedic Association (JOA) score for spinal cord function and VAS score for pain recovery was assessed. Results JOA and visual analog scale (VAS) score were significantly improved at 14±5.9 month follow-up compared with pretreatment values. Complete or almost complete anatomical reduction was observed in all 21 patients. All patients had good bony fusion at the final follow-up. No screw-loosening or atlantoaxial redislocation occurred in 21 cases. The only complication was mild numbness in the C2 innervation area of the posterior occipital region in 6 cases, which had no effect on life. Conclusions The results suggested that posterior atlantoaxial rod, screw fixation system, and posterior interfacet fusion could achieve satisfactory initial results for the treatment of atlantoaxial dislocation combined with osteoporosis.
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Affiliation(s)
- Qingfeng Shen
- Department of Spine Surgery, Tianjin Union Medical Center, Tianjin, China (mainland)
| | - Yingpeng Xia
- Department of Spine Surgery, Tianjin Union Medical Center, Tianjin, China (mainland)
| | - Tiantong Xu
- Department of Spine Surgery, Tianjin Union Medical Center, Tianjin, China (mainland)
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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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Duan W, Du Y, Qi T, Jiang B, Wang K, Liu Z, Guan J, Wang X, Wu H, Chen Z, Jian F. The Value and Limitation of Cervical Traction in the Evaluation of the Reducibility of Atlantoaxial Dislocation and Basilar Invagination Using the Intraoperative O-Arm. World Neurosurg 2019; 132:e324-e332. [PMID: 31476460 DOI: 10.1016/j.wneu.2019.08.160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the value and limitation of cervical traction in the evaluation of the reducibility of atlantoaxial dislocation (AAD) and basilar invagination (BI) using the intraoperative O-arm. METHODS A total of 22 patients with hyperextensive, irreducible AAD were included. The cervical traction test under general anesthesia was performed, and the degree of reduction was evaluated using the O-arm before the operation started. The traction effects both vertically and horizontally were evaluated. All cases then underwent modified direct posterior reduction and fixation. Clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) scale. Radiologic measurements included the anterior atlantodental interval, the distance of odontoid tip above Chamberlain line, and the clivus-canal angle. Magnetic resonance imaging signal changes, size of syringomyelia, and the space ventral to medulla also were used to evaluate the postoperative reduction result. RESULTS After the cervical traction test, 7 patients achieved incomplete reduction, 5 achieved only vertical reduction, 6 achieved only horizontal reduction, and 4 achieved complete reduction in both horizontal and vertical orientations as assessed by the O-arm. All patients underwent a direct reduction technique. The mean JOA score increased from 11.1 to 14.5. Complete reduction of AAD and BI were achieved in 19 patients (86.4%), with partial reduction achieved in 3 (13.6%). Sufficient cerebrospinal fluid space anterior to the medulla with improved JOA score was achieved in the 3 partially reduced patients. CONCLUSIONS With the innovations of direct posterior reduction techniques, cervical traction under anesthesia may not sufficiently predict the reducibility of BI and AAD. Cervical traction still plays an important role during the direct posterior reduction procedure.
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Affiliation(s)
- Wanru Duan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yueqi Du
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tengfei Qi
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Bowen Jiang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kai Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhenlei Liu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jian Guan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xingwen Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hao Wu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zan Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fengzeng Jian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Lin L, Zhu M, Peng P, Zhang X, Zhou X, Li J. Patient-specific drill template for C2 transoral pedicle insertion in complete reduction of atlantoaxial dislocation: cadaveric efficacy and accuracy assessments. J Orthop Surg Res 2019; 14:141. [PMID: 31096990 PMCID: PMC6524296 DOI: 10.1186/s13018-019-1189-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/03/2019] [Indexed: 11/29/2022] Open
Abstract
Background The transoral atlantoaxial reduction plate (TARP) is an effective advance in the treatment of atlantoaxial dislocation (AAD) and can enable the performance of anterior atlantoaxial release, reduction, decompression, and internal fixation in a one-stage operation. However, accurate transoral C2 pedicle insertion (C2TOPI) remains a challenge. The aim of this study is to develop a grouped patient-specific drill template (PDT) specifically for AAD with complete reduction and, furthermore, to compare its efficacy and accuracy in facilitating C2TOPI. Methods After CT scanning, ten cadaveric C2 specimens were randomly assigned to two groups (the PDT and freehand group). A grouped PDT specifically for AAD with complete reduction was designed and manufactured. C2TOPI was performed using the PDT or the fluoroscopy-guided freehand technique. Postoperative CT scans were subsequently performed to analyze the deviations at the centroid of the cross section at the midpoint of the pedicle. Screw position grades were also assessed in both groups. Results Compared to the freehand group, the PDT group had a significantly shorter surgery time (p < 0.001). Significant differences between the two groups were observed in the absolute value of the deviations at the centroid of the pedicle on either the axial or sagittal planes (p < 0.05). No significant difference was found in the screw positions between the two groups (p > 0.05); however, two unacceptable breaches (20%) occurred in the freehand group. Conclusion A specifically designed PDT could provide an accurate and easy-to-apply method for C2TOPI in AAD with complete reduction.
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Affiliation(s)
- Lijun Lin
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, 253 Gongye Street, Haizhu District, Guangzhou, Guangdong, China
| | - Meisong Zhu
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, 253 Gongye Street, Haizhu District, Guangzhou, Guangdong, China
| | - Peng Peng
- Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Sciences, Southern Medical University, 1063 Shatai Nan Road, Baiyun District, Guangzhou, Guangdong, China
| | - Xintao Zhang
- Department of Radiology, The Third Affiliated Hospital, Southern Medical University, 183 Zhongshandadao Xi, Tianhe District, Guangzhou, Guangdong, China
| | - Xiaoqi Zhou
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, 253 Gongye Street, Haizhu District, Guangzhou, Guangdong, China
| | - Jianyi Li
- Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Sciences, Southern Medical University, 1063 Shatai Nan Road, Baiyun District, Guangzhou, Guangdong, China. .,Nanhai Hospital, Southern Medical University, 28 Liguan Road, Lishui Town, Nanhai District, Foshan, Guangdong, China.
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Guan J, Chen Z, Wu H, Yao Q, Wang Q, Zhang C, Qi T, Wang K, Duan W, Gao J, Li Y, Jian F. Effectiveness of posterior reduction and fixation in atlantoaxial dislocation: a retrospective cohort study of 135 patients with a treatment algorithm proposal. 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 2019; 28:1053-1063. [PMID: 30604297 DOI: 10.1007/s00586-018-05869-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 12/21/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE Surgical procedures on atlantoaxial dislocation remain controversial. The aim of this observational retrospective study was to investigate the treatment algorithm of surgical procedures. METHODS According to CT and intraoperative evaluation during direct posterior reduction, 135 AAD cases were categorized into three groups: Group I: reducible dislocation; Group II: irreducible dislocation (Group IIa: effective decompression achieved after posterior reduction; Group IIb: no effective decompression after posterior reduction); and Group III: fixed dislocation. Group III presented with extensive bony fusions. Group I and Group IIa were treated with direct posterior reduction and fixation. Group IIb underwent posterior fixation and transoral odontoidectomy. Group III underwent transoral odontoidectomy alone. Japanese Orthopedic Association scores (JOA) were assessed to evaluate clinical status before and 6, 12 months after surgery. RESULTS Our study included 118 Group I cases, 16 Group II cases (Group IIa: 11 cases; Group IIb: 5 cases), and one Group III case. Follow-up ranged from 12 to 36 months. PRIMARY OUTCOME Anatomic atlantoaxial reduction was achieved in 118 of 135 patients (87.4%). Clinical improvements were seen in 96.3% (130/135) all the patients. Solid atlantoaxial fusion was shown in 134 patients. Secondary outcome: The overall complication rate was 3.7% (5/135). For Group I, the mean postoperative 6-month JOA was 14.5 versus 12.2 in preoperative patients (paired Student's t test, P < 0.01). CONCLUSIONS This article proposes a clinical procedure that assists with therapeutic decision making and indicates the severity and difficulty of reduction of the atlantoaxial joint. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Jian Guan
- Department of Neurosurgery, Division of Spine, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, People's Republic of China
| | - Zan Chen
- Department of Neurosurgery, Division of Spine, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, People's Republic of China
| | - Hao Wu
- Department of Neurosurgery, Division of Spine, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, People's Republic of China
| | - Qingyu Yao
- Department of Neurosurgery, Division of Spine, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, People's Republic of China
| | - Qu Wang
- Department of Neurosurgery, The People's Hospital of Guizhou Province, Guiyang, People's Republic of China
| | - Can Zhang
- Department of Neurosurgery, Division of Spine, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, People's Republic of China
| | - Tengfei Qi
- Department of Neurosurgery, Division of Spine, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, People's Republic of China
| | - Kai Wang
- Department of Neurosurgery, Division of Spine, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, People's Republic of China
| | - Wanru Duan
- Department of Neurosurgery, Division of Spine, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, People's Republic of China
| | - Jun Gao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yongning Li
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Fengzeng Jian
- Department of Neurosurgery, Division of Spine, China International Neurological Institute, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100053, People's Republic of China.
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Ma F, Kang M, Liao YH, Lee GZ, Tang Q, Tang C, Wang Q, Zhong DJ. The use of intraoperative traction for achieving reduction of irreducible atlantoaxial dislocation caused by different craniovertebral junction pathologies. Clin Neurol Neurosurg 2018; 175:98-105. [PMID: 30390484 DOI: 10.1016/j.clineuro.2018.10.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 10/19/2018] [Accepted: 10/28/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the usefulness of intraoperative traction in the selection of the surgical procedure for irreducible atlantoaxial dislocation (IAAD) caused by different craniovertebral junction (CVJ) pathologies. PATIENTS AND METHODS Forty-three patients who were diagnosed with IAAD and who underwent surgery between January 2008 and May 2017 in our hospital were included in the study. All of the patients received skull traction under general anesthesia. Based on the traction results, the patients underwent one of the following surgeries: posterior fixation and fusion only, posterior atlantoaxial lateral mass joint release followed by fixation and fusion, or anterior release followed by posterior fixation and fusion. The classification system was defined accordingly. The treatment efficacy was evaluated based on the improvement of clinical symptoms and radiological findings. RESULTS Four patients were categorized as Type A, twenty patients as Type B1, twelve patients as Type B2, and seven patients as Type C. Thirty-seven patients (86.0%) achieved complete reduction and six patients (14.0%) achieved greater than 50% reduction. Bony fusion was achieved in all patients at 6 months after the operation. The average Japanese Orthopaedic Association (JOA) score improved from 10.2 ± 2.1 before surgery to 15.0 ± 1.2 at the final follow-up. According to the Symon clinical standard, the total effectiveness rate was 97.7%, and 72.1% of the patients showed excellent clinical outcomes. CONCLUSION Intraoperative traction is an effective and safe method to assist the selection of surgical methods for patients with IAAD caused by different CVJ etiologies.
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Affiliation(s)
- Fei Ma
- Department of Spine Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Min Kang
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Ye Hui Liao
- Department of Spine Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Guang Zhou Lee
- Department of Spine Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Qiang Tang
- Department of Spine Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Chao Tang
- Department of Spine Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Qing Wang
- Department of Spine Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - De Jun Zhong
- Department of Spine Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.
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Wu X, Wood KB, Gao Y, Li S, Wang J, Ge T, Zhao B, Shao Z, Yang S, Yang C. Surgical strategies for the treatment of os odontoideum with atlantoaxial dislocation. J Neurosurg Spine 2018; 28:131-139. [PMID: 29148933 DOI: 10.3171/2017.5.spine161211] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThis study aimed to compare the clinical results of using posterior fixation and fusion with or without anterior decompression to treat os odontoideum with atlantoaxial dislocation.METHODSTwenty-five consecutive patients with os odontoideum were included in this study. Sixteen patients with reducible atlantoaxial dislocation were treated by single-level posterior fusion and stabilization; the other 9 were treated with posterior fusion and stabilization combined with transoral decompression. Pre- and postoperative CT scans and MR images were obtained.RESULTSTwenty-four patients were followed for 24–54 months (average 36.5 months). Postoperative CT scans indicated that all pedicle screws were placed satisfactorily except in 2 cases, in which the screws slightly penetrated the transverse foramen. Postoperative MR images demonstrated that sufficient decompression of the spinal cord was obtained in all patients. Complications included 1 case each of pedicle screw breakage, pharynx ulcer, and persistent pharynx discomfort. Statistical analysis of all cases revealed that mean Japanese Orthopaedic Association scores improved from a preoperative score of 10.2 (range 7–13) to a postoperative score of 15.6 (range 11–18).CONCLUSIONSPatients who have os odontoideum with a reducible atlantoaxial dislocation can be effectively treated with single-level posterior fusion and stabilization. Combined transoral decompression and posterior fusion and stabilization is recommended for those with irreducible atlantoaxial dislocation.
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Affiliation(s)
- Xinghuo Wu
- 1Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; and
| | - Kirkham B. Wood
- 2Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Yong Gao
- 1Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; and
| | - Shuai Li
- 1Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; and
| | - Jing Wang
- 1Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; and
| | - Ting Ge
- 1Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; and
| | - Boming Zhao
- 1Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; and
| | - Zengwu Shao
- 1Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; and
| | - Shuhua Yang
- 1Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; and
| | - Cao Yang
- 1Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; and
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Lan S, Xu J, Wu Z, Xia H, Ma X, Zhang K, Ai F, Wang J, Yin Q, Yi H, Duan M. Atlantoaxial Joint Distraction for the Treatment of Basilar Invagination: Clinical Outcomes and Radiographic Evaluation. World Neurosurg 2017; 111:e135-e141. [PMID: 29248777 DOI: 10.1016/j.wneu.2017.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 12/01/2017] [Accepted: 12/04/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the causes of partial remission in patients with basilar invagination (BI) and irreducible atlantoaxial dislocation (IAAD) treated with transoral atlantoaxial reduction plate (TARP) without odontoidectomy and quantify the distance of odontoid descent. METHODS Between August 2010 and July 2012, 22 consecutive patients with BI with IAAD who underwent TARP surgery were reviewed. The preoperative and postoperative radiographic parameters were evaluated. Follow-up data and the symptom treatment interval (STI), defined as the interval between the onset of symptoms and surgical treatment, were assessed. Neurological function was evaluated as neurologic improvement, defined as ([Postoperative Japanese Orthopedic Association (JOA) score] - [Preoperative JOA score])/(17 - [Preoperative JOA score]). The patients were assigned to group A (<50%) or group B (≥50%) based on their level of neurologic improvement. RESULTS All 22 patients improved clinically to varying degrees. The mean preoperative STI was 105.6 ± 67.6 months for group A and 45.3 ± 46.7 months for group B (P < 0.05). There were no significant between-group differences in follow-up (P > 0.05) or with respect to radiographic parameters (P > 0.05). Persistent brainstem compression was observed in 1 patient, whose symptoms were not adequately relieved after revision surgery (transoral odontoidectomy and posterior decompression and fusion). No fixation failure was observed. CONCLUSIONS Descent of the odontoid process is useful for treating basilar invagination. TARP surgery without odontoidectomy may pull the dens caudally and ventrally to achieve sufficient decompression of the spinal cord. Neurologic improvement may be associated with STI.
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Affiliation(s)
- Sibin Lan
- Southern Medical University, Guangzhou, People's Republic of China; Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China
| | - Junjie Xu
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China.
| | - Zenghui Wu
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China
| | - Hong Xia
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China
| | - Xiangyang Ma
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China
| | - Kai Zhang
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China
| | - Fuzhi Ai
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China
| | - Jianhua Wang
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China
| | - Qingshui Yin
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China
| | - Honglei Yi
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China
| | - Mingyang Duan
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China
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Anterior submandibular retropharyngeal odontoid osteotomy and posterior atlantoaxial fusion for irreducible atlantoaxial dislocation associated with odontoid fracture malunion. 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 2017; 27:292-297. [PMID: 28608179 DOI: 10.1007/s00586-017-5167-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/15/2017] [Accepted: 06/01/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To report a case of complex odontoid fracture malunion accompanied by atlantoaxial dislocation which was treated with a new surgical approach. METHODS A 53-year-old female was admitted due to progressive symptoms with a stiff limp and unsteady gait. Preoperative examination, diagnostic radiography, computed tomography, and magnetic resonance imaging were performed following admission. The examinations showed odontoid fracture malunion, an old right axial zygapophyseal fracture, atlantoaxial dislocation, and spinal cord injury. Anterior submandibular retropharyngeal odontoid osteotomy and posterior atlantoaxial fusion were then performed. RESULTS Good reduction of the atlantoaxial dislocation was gained. The cervical spinal cord compression was significantly relieved and neurological function was also significantly improved. CONCLUSION Anterior submandibular retropharyngeal odontoid osteotomy and posterior atlantoaxial fusion fixation is an effective method for treating IAAD associated with odontoid fracture malunion, it avoids the adverse effects of anterior transoral odontoid osteotomy and provides a new option for the treatment of odontoid fracture malunion associated with atlantoaxial dislocation.
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Ma H, Dong L, Liu C, Yi P, Yang F, Tang X, Tan M. Modified technique of transoral release in one-stage anterior release and posterior reduction for irreducible atlantoaxial dislocation. J Orthop Sci 2016; 21:7-12. [PMID: 26686772 DOI: 10.1016/j.jos.2015.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 09/07/2015] [Accepted: 09/21/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND One-stage anterior release and posterior reduction is one of the most effective methods for irreducible atlantoaxial dislocation. However, the criteria of appropriate tissue release for successful posterior reduction is yet to be confirmed. Hence, an assistant technique using the transoral approach to verify satisfactory release is required. To evaluate the efficacy of the modified technique of transoral release for irreducible atlantoaxial dislocation (IAAD) with patients underwent one-stage anterior release and posterior reduction. METHODS Between January 2009 and June 2014, 23 consecutive patients diagnosed with IAAD free from bony union between the C1-C2 facet joints on reconstructive computed tomography scan underwent one-stage anterior release and posterior reduction after no response to 2 weeks of skull traction. During transoral release, an elevator was used as a lever repeatedly to confirm a 3-5 mm bilateral joint space between the lateral masses of the atlas and axis. The release was accomplished since a 3-5 mm joint space was achieved. After anterior release, posterior reduction and instrumented fusion were subsequently performed. RESULTS All patients were observed for an average of 18 (range 6-50) months. Nineteen of 23 patients achieved complete reduction while four had an incomplete reduction. Significant differences in pre- and postoperative JOA scores and cervicomedullary angle (CMA) were found. Twenty-one patients presenting with myelopathy had a JOA score of 12.9 at final follow-up, improved from 7.8 before surgery. The mean CMA improved to 143.5° postoperatively from 101.8° preoperatively. Bony fusion was confirmed in all cases under radiologic assessment during follow-up; there were no instrument failures. CONCLUSION The modified technique of transoral release provides appropriate criteria for anterior release, to achieve good posterior reduction without excessive tissue release or intraspinal manipulation, proving its value as an assistant technique in one-stage anterior release and posterior reduction for IAAD.
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Affiliation(s)
- Haoning Ma
- Graduate School of Peking Union Medical College, 100005, Beijing, China; Department of Spine Surgery, China-Japan Friendship Hospital, 100029, Beijing, China
| | - Liang Dong
- Graduate School of Peking Union Medical College, 100005, Beijing, China; Department of Spine Surgery, China-Japan Friendship Hospital, 100029, Beijing, China
| | - Chuyin Liu
- Department of Spine Surgery, China-Japan Friendship Hospital, 100029, Beijing, China; Graduate School of Beijing University of Chinese Medicine, 100029, Beijing, China
| | - Ping Yi
- Department of Spine Surgery, China-Japan Friendship Hospital, 100029, Beijing, China
| | - Feng Yang
- Department of Spine Surgery, China-Japan Friendship Hospital, 100029, Beijing, China
| | - Xiangsheng Tang
- Department of Spine Surgery, China-Japan Friendship Hospital, 100029, Beijing, China
| | - Mingsheng Tan
- Graduate School of Peking Union Medical College, 100005, Beijing, China; Department of Spine Surgery, China-Japan Friendship Hospital, 100029, Beijing, China.
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Zhai MY, Wang CP, Liu F, Liu YQ, Zhang P. The efficacy of pedicle screw instrument in treatment of irreducible atlantoaxial dislocation. Arch Orthop Trauma Surg 2015; 135:1193-9. [PMID: 26119708 DOI: 10.1007/s00402-015-2261-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore the effect of pedicle screw instrument in treatment of irreducible atlantoaxial dislocation. PATIENTS AND METHOD From June 2003 to February 2009, 14 cases of atlas dislocation with upper cervical cord compression were enrolled and anterior transoral soft tissue release combined with posterior reduction and pedicle screw fixation were performed. CT, MRI and radiograph were used preoperatively, and screw placement and bone graft were administered in all cases intraoperatively. Cervical collars were used for 3 months. RESULTS Screws were successfully placed in atlas in all cases. The average follow-up period was 18 months. Bone fusion was observed in all cases without the following complications: neurologic symptoms, internal fixation failure and redislocation. Neurological recovery was observed in all 14 cases. CONCLUSIONS Pedicle screw instrument has the following advantages in atlas and axis injury treatment: direct screw placement, short-segment fusion, intraoperative reduction and high fusion rate, which should be a better surgical method for the treatment of atlantoaxial dislocation.
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Affiliation(s)
- Ming-Yu Zhai
- Spinal Surgery Center of Ping Le Orthopaedic Hospital, Shenzhen, 518001, Guang Dong, China,
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Wu Z, Xu J, Wang Z, Xia H, Zhang Q, Ma X, Zhang K. Transoral approach for revision surgery of os odontoideum with atlantoaxial dislocation. Orthopedics 2014; 37:e851-5. [PMID: 25350632 DOI: 10.3928/01477447-20140825-94] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 03/04/2014] [Indexed: 02/03/2023]
Abstract
Revision surgery for os odontoideum with irreducible atlantoaxial dislocation with a transoral approach is not commonly seen. Typically, management of this type of atlantoaxial dislocation is through posterior fixation and fusion or transoral decompression and posterior fusion. This report describes revision surgery in a patient with os odontoideum who was treated with a transoral approach. A 50-year-old man was diagnosed with os odontoideum and atlantoaxial dislocation in 2007 and was treated surgically with posterior occipitocervical internal fixation and fusion. In 2012, he had recurrence of neck pain and numbness of the limbs. Neurologic function was grade D according to the standard neurologic classification of spinal cord injury from the American Spinal Injury Association. Because this was a revision surgery, the internal fixation implant was removed through a posterior approach and a transoral approach was used for release, reduction, internal fixation, and fusion. Two 6-mm cages filled with autogenous bone were introduced into the lateral mass spaces for bony fusion and distraction, and 2 cervical compressive mini-frames were used for fixation. Complete atlantoaxial reduction and decompression of the spinal cord were achieved. The patient reported improvement of symptoms after surgery. Movement of the extremities increased from grade III force to grade V, and neurologic status improved from American Spinal Injury Association grade D to grade E. A transoral approach for release, reduction, bony fusion, and fixation could be an effective procedure for the treatment of os odontoideum with irreducible atlantoaxial dislocation. It provides a new option for bony fusion and internal fixation of the atlantoaxial joint.
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Treatment of basilar invagination with atlantoaxial dislocation: atlantoaxial joint distraction and fixation with transoral atlantoaxial reduction plate (TARP) without odontoidectomy. 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 2014; 23:1648-55. [DOI: 10.1007/s00586-014-3378-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 05/06/2014] [Accepted: 05/07/2014] [Indexed: 10/25/2022]
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Li X, Ai F, Xia H, Wu Z, Ma X, Yin Q. Radiographic and clinical assessment on the accuracy and complications of C1 anterior lateral mass and C2 anterior pedicle screw placement in the TARP-III procedure: a study of 106 patients. 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 2014; 23:1712-9. [PMID: 24838426 DOI: 10.1007/s00586-014-3353-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 04/26/2014] [Accepted: 04/26/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate the (1) radiographic and clinical accuracy of C1 anterior lateral mass screw (C1ALMS) and C2 anterior pedicle screw (C2APS) placement in the transoral atlantoaxial reduction plate (TARP)-III procedure, (2) screw insertion-associated clinical complications and (3) fusion status between C1 and C2. METHODS Radiographic and clinical data were obtained from the electronic medical record system. Studies were carried out to assess the accuracy of C1ALMS and C2APS placement, the screw insertion-associated clinical complications and the fusion status between C1 and C2. Placement of the screws was assessed using the modified All India Institute of Medical Sciences outcome-based classification. RESULTS Two-hundred and twelve C1ALMS and 207 C2APS in 106 patients were assessed. The ideal accurate rates were 92.0% (195) and 53.1% (110), and the acceptable accurate rates were 97.6% (207) and 87.0% (180), respectively. One patient died postoperatively due to C2 screw misplacement. There were no symptoms of neurologic and vertebral artery injuries in the rest of the patients. 102 patients (97.1%) achieved solid fusion between C1 and C2. No instrumentation failure due to delayed union or nonunion was observed. CONCLUSION C1ALMS placement in TARP-III procedures appears to be safe. The cortical breach rate of C2APS is high though clinically the neurovascular complication rate is similar to that of posterior atlantoaxial procedures. Advanced navigation strategies may help improve the accuracy of C2APS placement and decrease potential complications.
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Affiliation(s)
- Xueshi Li
- Southern Medical University, Guangzhou, 510515, China
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