Ventral release and posterior screw/rod implant fusion for irreducible atlantoaxial dislocation: one-year follow-up

doi:10.3969/j.issn.2095-4344.2014.13.013

Abstract

Abstract:

BACKGROUND: Transoral ventral release and posterior fusion have predominated in the treatment of irreducible atlantoaxial dislocation, but there is no consistent conclusion on the clinical efficacy.
OBJECTIVE: To explore the clinical outcomes of transoral ventral release and posterior fusion and screw/rod implantation in the treatment of irreducible atlantoaxial dislocation.
METHODS: A total of 32 patients with irreducible atlantoaxial dislocation undergoing thetransoral ventral release and posterior fusion were selected. After treatment, they received cervical anteroposterior and lateral digital DR and cervical MRI examinations to understand the conditions of nerve compression and bone fusion. The recovery of nerve function was evaluated using Japanese Orthopaedic Association before treatment, 6 months after treatment and during final follow-up.
RESULTS AND CONCLUSION: Post-treatment, 29 patients were followed-up for an average period of 12 months. (1) All the patients obtained perfect atlantoaxial joint reduction and bone fusion. This achieved reduction and reconstruction of spinal column stability. (2) Spinal compression was obviously lessened after treatment in all patients, and nerve functions were improved to different degrees. Significant differences in Japanese Orthopaedic Association score were detected between 6 months post-treatment, final follow-up and pre-treatment (P < 0.05). (3) There were no serious intraoperative complications such as spinal cord or vertebral artery injuries. Postoperative complications such as infection or burst were also not found. (4) Imaging evaluation revealed that transoral ventral release and posterior fusion is safe and effective for treatment of irreducible atlantoaxial dislocation.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: cervical vertebrae, atlanto-axial joint, dislocations, spinal fusion, internal fixators

CLC Number:

R318

Sun Xiu-qin, Liao Wen-sheng, Wang Li-min, Bao Heng, Wang Wei-dong, Jian Yan-peng. Ventral release and posterior screw/rod implant fusion for irreducible atlantoaxial dislocation: one-year follow-up[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(13): 2043-2048.

Figures/Tables 3

References

[1] Dickman CA, Locantro J, Fessler RG.The influence of transoral odontoid resection on stability of the craniovertebral junction.J Neurosurg. 1992;77(4):525-530.

[2] 尹庆水,刘景发,夏虹,等.经口咽前路枢椎体次全切除椎管减压术[J].中国脊柱脊髓杂志,2004,14(1):9-11.

[3] 杨双石,刘景发,吴增晖,等.经口咽入路治疗枕颈部病变(附43例)[J].中国矫形外科杂志,2000,7(11):1071-1073.

[4] 金明熙,谢林,李小川,等.颈椎管单开门术后颈椎稳定性变化及其对术后效果的影响[J].中国医科大学学报,2000,29(增):75.

[5] Melcher RP, Puttlitz CM, Kleinstueck FS,et al.Biomechanical testing of posterior atlantoaxial fixation techniques.Spine (Phila Pa 1976). 2002;27(22):2435-2440.

[6] Yin Q, Ai F, Zhang K,et al.Irreducible anterior atlantoaxial dislocation: one-stage treatment with a transoral atlantoaxial reduction plate fixation and fusion. Report of 5 cases and review of the literature.Spine (Phila Pa 1976). 2005;30(13): E375-381.

[7] 罗发明,黄思庆,裴福兴,等.枕颈后外侧入路显露枢椎齿突的应用解剖[J].中华骨科杂志,2000,20(2):75-78.

[8] Finn MA, Bishop FS, Dailey AT.Surgical treatment of occipitocervical instability.Neurosurgery. 2008;63(5):961-968.

[9] Pratt H, Davies E, King L.Traumatic injuries of the c1/c2 complex: computed tomographic imaging appearances.Curr Probl Diagn Radiol. 2008;37(1):26-38.

[10] 陈晓雷,刘宁,朱风仪,等. 经口咽入路治疗颅颈区腹侧畸形的解剖及临床研究[J]. 南京医科大学学报:自然科学版,2008, 28(5): 673-676.

[11] Naderi S, Pamir MN.Further cranial settling of the upper cervical spine following odontoidectomy. Report of two cases.J Neurosurg. 2001;95(2 Suppl):246-249.

[12] Menezes AH.Surgical approaches: postoperative care and complications "transoral-transpalatopharyngeal approach to the craniocervical junction".Childs Nerv Syst. 2008;24(10): 1187-1193.

[13] 乔广宇,张远征,余新光,等.经口咽入路行延髓-颈髓腹侧减压治疗颅颈交界区畸形[J].军医进修学院学报,2010,31(4):309-311.

[14] Goto S, Mochizuki M, Kita T,et al.Transoral joint release of the dislocated atlantoaxial joints combined with posterior reduction and fusion for a late infantile atlantoaxial rotatory fixation. A case report.Spine (Phila Pa 1976). 1998;23(13): 1485-1489.

[15] Tong FC, Cloft HJ, Joseph GJ,et al.Transoral approach to cervical vertebroplasty for multiple myeloma.AJR Am J Roentgenol. 2000;175(5):1322-1324.

[16] 王健,倪斌.经口手术入路治疗颅颈交界区病变[J].中国脊柱脊髓杂志, 2005,15(1):52-53.

[17] 王超,阎明,周海涛,等.难复性寰枢关节脱位的手术治疗[J].中华骨科杂志,2004,24(5):290-294.

[18] 尹庆水,刘景发,夏虹,等.经口咽前、后路一期手术治疗难复性寰枢椎脱位伴脊髓压迫症[J].中国脊柱脊髓杂志,2001,11(2): 100-102.

[19] 韩伟,田晓滨,李波,等.经口咽入路治疗陈旧性寰枢关节脱位12例疗效观察[J].贵州医药,2008,32(10):924-925.

[20] 肖嵩华,毛克亚,王岩,等.前后路手术治疗颅颈交界区疾病[J].脊柱外科杂志,2009,7(1):1-3.

[21] 姜文涛,翟明玉,方华宴.前后路一期手术治疗难复性寰枢关节脱位13例[J].人民军医,2012,55(4):328-329.

[22] 王健,倪斌.经口手术入路治疗颅颈交界区病变[J].中国脊柱脊髓杂志,2005,15(1):52-54.

[23] 胥少汀,葛宝丰,徐印坎.实用骨科学[M].4版.北京:人民军医出版社,2012.

[24] 刘忠军,陈仲强,郭昭庆,等.脊柱外科手术操作与技巧[M].北京:人民卫生出版社,2009.

[25] 中华人民共和国国务院.医疗机构管理条例.1994-09-01.

[26] 李世民,党耕町.临床骨科学[M].天津:天津科学技术出版社, 1998:629.

[27] Veres R, Bagó A, Fedorcsák I.Early experiences with image-guided transoral surgery for the pathologies of the upper cervical spine.Spine (Phila Pa 1976). 2001;26(12): 1385-1388.

[28] Tong FC, Cloft HJ, Joseph GJ,et al.Transoral approach to cervical vertebroplasty for multiple myeloma.AJR Am J Roentgenol. 2000;175(5):1322-1324.

[29] Menendez JA, Wright NM.Techniques of posterior C1-C2 stabilization.Neurosurgery. 2007;60(1 Supp1 1):S103-111.

[30] Tubbs RS, Webb D, Smyth MD,et al.Magnetic resonance imaging evidence of posterior pharynx denervation in pediatric patients with Chiari I malformation and absent gag reflex.J Neurosurg. 2004;101(1 Suppl):21-24.

[31] 陈耿,韩立新,曹惠霞,等.经口咽前路寰枢椎复位钢板置入内固定治疗颅颈交界部畸形的MRI评价[J].中国组织工程研究与临床康复,2010,14(48):9003-9006.

[32] 尹庆水,刘景发,夏虹,等.经口咽前路枢椎体次全切除椎管减压术[J].中国脊柱脊髓杂志,2004,14(1):9-11.

[33] 郝定均,贺宝荣,雷伟,等. Cervifix在陈旧性寰枢椎脱位并高位颈髓压迫症中的应用[J].中国矫形外科杂志,2004,12(18):1365- 1368.

[34] Weng C, Wang LM, Wang WD,et al.Bipartite atlas with os odontoideum and synovial cyst: case report and review literature.Spine (Phila Pa 1976). 2010;35(12):E568-575.

[35] 尹庆水,刘景发,夏虹,等.经口咽前、后路一期手术治疗难复性寰枢椎脱位伴脊髓压迫症[J].中国脊柱脊髓杂志,2001,11(2): 100-102.

[36] Jones DC, Hayter JP, Vaughan ED,et al. Oropharyngeal morbidity following transoral approaches to the upper cervical spine.Int J Oral Maxillofac Surg. 1998;27(4):295-298.

[37] Kelly BP, Glaser JA, DiAngelo DJ.Biomechanical comparison of a novel C1 posterior locking plate with the harms technique in a C1-C2 fixation model.Spine (Phila Pa 1976). 2008;33(24): E920-925.

[38] Ma XY, Yin QS, Wu ZH,et al. Anatomic considerations for the pedicle screw placement in the first cervical vertebra.Spine (Phila Pa 1976). 2005;30(13):1519-1523.

[39] Igarashi T, Kikuchi S, Sato K,et al.Anatomic study of the axis for surgical planning of transarticular screw fixation.Clin Orthop Relat Res. 2003;(408):162-166.

[40] Bransford RJ, Russo AJ, Freeborn M,et al.Posterior C2 instrumentation: accuracy and complications associated with four techniques.Spine (Phila Pa 1976). 2011;36(14):E936- 943.

[41] Lapsiwala SB, Anderson PA, Oza A,et al. Biomechanical comparison of four C1 to C2 rigid fixative techniques: anterior transarticular, posterior transarticular, C1 to C2 pedicle, and C1 to C2 intralaminar screws.Neurosurgery. 2006;58(3): 516-521.