Research progress of intra-articular atlantoaxial mass fusion and its cage
10.3760/cma.j.cn121113-20240624-00364
- VernacularTitle:寰枢椎侧块关节内融合术及其融合器的研究进展
- Author:
Hua LIU
1
;
Tao ZHANG
;
Huaixi FAN
;
Tianyun SHI
;
Hao WANG
;
Songkai LI
Author Information
1. 甘肃中医药大学第一临床医学院，兰州 730000
- Publication Type:Journal Article
- Keywords:
Cervical atlas;
Axis, cervical vertebra;
Dislocations;
Spinal fusion;
Cage
- From:
Chinese Journal of Orthopaedics
2024;44(24):1619-1627
- CountryChina
- Language:Chinese
-
Abstract:
An essential treatment for atlantoaxial dislocation is posterior atlantoaxial fusion. The current intra-articular fusion of the atlantoaxial lateral mass joint demonstrates a higher bone fusion rate, requires a smaller amount of bone graft, and has a lower incidence of complications. Although it has been employed in clinical practice, the atlantoaxial lateral mass intra-articular fusion cage is not yet widely utilized. Atlantoaxial instability and reducible atlantoaxial dislocation can be managed with simple posterior reduction, fixation, and atlantoaxial lateral mass intra-articular fusion. For patients with irreducible atlantoaxial dislocation, such as those with severe basilar invagination or obstructive anterior bone structures, transoral release is necessary, and anterior fusion cage placement is also feasible. Both posterior and anterior atlantoaxial lateral mass intra-articular fusion have seen significant improvements in surgical techniques, bone graft materials, and fusion cages. Among them, the procedure is evolving from the classic open approach to a more minimally invasive one. Bone graft materials include massive iliac bone, granular cancellous bone, fibula, autologous bone harvested from the C 1 posterior arch and C 2 lamina, and allogeneic bone, reflecting an increasingly diverse selection. Fusion cages have evolved from simple spacers to titanium blocks and further to cages that are anatomically adapted to the atlantoaxial joint, offering high bone fusion rates and various specifications of width and height. In anterior fusion cages, the circular design facilitates easy placement, while the wedge-shaped cage, when inserted transorally, better conforms to the physiological structure of the atlantoaxial lateral mass joint, resulting in improved surgical outcomes.The 3D-printed locking cage provides robust anterior support for fixation and fusion without the need for additional bone grafting. Anterior fusion cages are particularly suitable for patients with partial irreducible atlantoaxial dislocation requiring transoral release. Posterior cages, such as the cylindrical threaded cage, offer immediate stability. Customized cages exhibit more uniform stress distribution and can reduce cage subsidence. The posterior fusion cage has broad applicability and is suitable for patients with basilar invagination and atlantoaxial dislocation. The continuous advancements of fusion cages, bone graft materials, and surgical techniques will be from the aspects of stability, safety, and fusion rate to optimize the atlantoaxial lateral mass intra-articular fusion.
