Surgical treatment of irreducible atlantoaxial dislocation with single-stage anterior and posterior approach in 17 cases

Abstract:

Objective：To summarize the therapeutic effect of single-stage anterior release and reduction through oral pharynx and pos－terior fixation and fusion for irreducible atlantoaxial dislocation. Methods：Seventeen cases of irreducible atlantoaxial dislocation were treated in our hospital from November 2006 to August 2011 including 10 males and 7 females aged from 31 years to 68 years（aver－aged 46.5 years）. The 17 patients included 9 patients with obsolete odontoid process fracture，2 with inborn dissociation odontoid pro－cess，4 with atlan-occipital fusion deformation，2 with rheumatoid disease. Japanese Orthopaedic Association（JOA） scores ranged from 4 to 11 with an average of 7.47±2.15. All dislocation could not be reduced through skull traction under anesthesia. Anterior release and reduction through oral pharynx was performed and posterior fixation and fusion was performed by one stage. Among posterior fix－ation and fusion，13 were performed through atlantoaxial pedicle，4 were performed through dentata pedicle and occipital. Results：All patients pulled through perioperative period securely. Complication including arteria vertebralis injury，spinal cord injury and incision infection were not occurred. All patients were followed up for 9 to 56 months，with an average of 32.6 months. All patients gained anatomic reduction and bone fusion. At latest time follow up，JOA scores ranged from 11 to 17 with an average of 14.70±2.22. Conclusions：With the merits of sufficient reduction，thorough decompression and good spinal column stability reconstruction，single-stage anterior release and reduction through oral pharynx and posterior fixation and fusion is effective in the treatment of irreducible atlantoaxial dislocation.