Single-stage Anterior Release and Sequential Posterior Fusion for Irreducible Atlantoaxial Dislocation

2016 ◽  
Vol 29 (5) ◽  
pp. E240-E245 ◽  
Author(s):  
Dingjun Hao ◽  
Baorong He ◽  
Yonghong Zheng ◽  
Zhenxing Zhang
Keyword(s):  
Atlantoaxial Dislocation ◽  
Single Stage ◽  
Posterior Fusion ◽  
Anterior Release ◽  
Irreducible Atlantoaxial Dislocation

Management of pediatric patients with irreducible atlantoaxial dislocation: transoral anterior release, reduction, and fixation

2019 ◽  
Vol 24 (3) ◽  
pp. 323-329
Author(s):  
Changrong Zhu ◽  
Jianhua Wang ◽  
Zenghui Wu ◽  
Xiangyang Ma ◽  
Fuzhi Ai ◽  
...  
Keyword(s):  
Spinal Injury ◽  
Posterior Instrumentation ◽  
Basilar Invagination ◽  
Atlantoaxial Dislocation ◽  
Neurological Deficits ◽  
Os Odontoideum ◽  
Complete Control ◽  
Anterior Release ◽  
One Stage ◽  
Irreducible Atlantoaxial Dislocation

OBJECTIVEAlthough transoral atlantoaxial reduction plate (TARP) surgery has been confirmed to be safe and effective for adults who have irreducible atlantoaxial dislocation (IAAD) with or without basilar invagination or upper cervical revision surgery, it is rarely used to treat these disorders in children. The authors of this study aimed to report on the use of the anterior technique in treating pediatric IAAD.METHODSIn this retrospective study, the authors identified 8 consecutive patients with IAAD who had undergone surgical reduction at a single institution in the period between January 2011 and June 2104. The patients consisted of 5 males and 3 females. Three had os odontoideum, 2 had basilar invagination, and the other 3 experienced atlantoaxial rotatory fixed dislocation (AARFD). They were all treated using transoral anterior release, reduction, and fusion with the TARP. Preoperative and postoperative CT scans and MR images were obtained. American Spinal Injury Association (ASIA) Impairment Scale grades were determined.RESULTSAll symptoms were relieved in all 8 patients but to varying degrees. Intraoperative loose reduction and fixation of C1–2 were achieved in one stage. The 4 patients with preoperative neurological deficits were significantly improved after surgery, and their latest follow-ups indicated that their ASIA Impairment Scale grades had improved to E. Postoperative pneumonia occurred in 1 patient but was under complete control after anti-infective therapy and fiber optic–guided sputum suction.CONCLUSIONSOne-stage transoral anterior release, reduction, and fixation is an effective, reliable, and safe means of treating pediatric IAAD. The midterm clinical results are satisfactory, with the technique eliminating the need for interval traction and/or second-stage posterior instrumentation and fusion.

scholarly journals Surgical strategies for the treatment of os odontoideum with atlantoaxial dislocation

2018 ◽  
Vol 28 (2) ◽  
pp. 131-139 ◽  
Author(s):  
Xinghuo Wu ◽  
Kirkham B. Wood ◽  
Yong Gao ◽  
Shuai Li ◽  
Jing Wang ◽  
...  
Keyword(s):  
Atlantoaxial Dislocation ◽  
Posterior Fusion ◽  
Ct Scans ◽  
Os Odontoideum ◽  
Posterior Fixation ◽  
Mr Images ◽  
Single Level ◽  
Irreducible Atlantoaxial Dislocation ◽  
Screw Breakage ◽  
Transoral Decompression

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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