Reduction of the atlantoaxial dislocation associated with basilar invagination through single-stage posterior approach: using Xuanwu occipital-cervical reduction surgical suite

Wanru Duan; Zhenlei Liu; Jian Guan; Zhiyuan Xia; Xinghua Zhao; Qiang Jian; Haitao Lan; Zongmao Zhao; Fengzeng Jian; Zan Chen

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Reduction of the atlantoaxial dislocation associated with basilar invagination through single-stage posterior approach: using Xuanwu occipital-cervical reduction surgical suite

VernacularTitle: 应用宣武枕颈复位内固定系统一期后路手术治疗颅底凹陷寰枢椎脱位临床报告
Author: Wanru DUAN ¹ ; Zhenlei LIU ¹ ; Jian GUAN ¹ ; Zhiyuan XIA ¹ ; Xinghua ZHAO ¹ ; Qiang JIAN ¹ ; Haitao LAN ² ; Zongmao ZHAO ² ; Fengzeng JIAN ¹ ; Zan CHEN ¹
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1. Department of Neurosurgery, Xuanwu Hospital, Capital Medical Universiy, Beijing 100053, China
2. Department of Neurosurgery, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
Publication Type:Journal Article
Keywords: Atlanto-axial joint; Dislocation; Basilar invagination; Posterior approach
From: Chinese Journal of Surgery 2019;57(10):782-787
CountryChina
Language:Chinese
Abstract: Objective:To examine the effect of posterior reduction in atlantoaxial dislocation (AAD) associated with basilar invagination(BI) using Xuanwu occipital-cervical fusion system in single stage.
Methods:Thirty-seven AAD accompanied with BI cases treated at Department of Neurosurgery, Xuanwu Hospital, Capital Medical Universiy and the Second Hospital of Hebei Medical University were retrospective analyzed. There were 15 males and 22 females with age of (42.3±12.3) years (range: 18-69 years). All the cases had congenital osseous abnormalities, such as assimilation of atlas and abnormal cervical fusion. Anterior tissue was released through posterior route followed by cage implantation into facet joint and occipital-cervical fixation with cantilever technique. The clinical results were evaluated using Japanese Orthopedic Association scale(JOA) and the main radiological measurements including anterior atlantodental interval (ADI), the distance of odontoid tip above Chamberlain line, clivus-canal angle(CCA) and the length of syrinx were collected. The preoperative and postoperative JOA score and radiological measurements were compared by paired t-test.
Results:The mean JOA score of the patients increased from 10.5 to 14.4 at the one-year follow-up(t=14.3, P=0.00). Complete reduction of AAD and BI was achieved in 34 patients.The mean clivus-canal angle improved from (118.0±6.5) degrees preoperative to (143.7±5.0) degrees postoperative(t=6.2, P=0.00). Shrinkage of the syrinx was observed 1 week after surgery in 24 patients, and 6 months in 31 patients.Twenty-eight patients achieved bone fusion 6 months after surgery. All the patients achieved bone fusion 12 months after surgery. One-side vertebral artery occlusion was diagnosed in 1 case postoperatively for transient dizziness, and relieved in 2 weeks.Two patients developed moderate neck pain after surgery, and relieved in 1 month. No implant failure, spacer subsidence or infection was observed.
Conclusions:The treatment of AAD associated with BI using Xuanwu occipital-cervical fusion system from posterior approach in single stage is effective and safe. Cage implantation intraarticularly and fixation with cantilever technique achieve complete reduction in most cases.