Top

Published in:

04-11-2022 | Computed Tomography | Original Paper

Treatment of irreducible atlantoaxial dislocation by bony deformity osteotomy, remodeling, releasing, and plate fixating through transoral approach

Authors: Jianhua Wang, Hong Xia, Xiang yang Ma, Kai Zhang, SuoChao Fu, Qiang Tu, Junjie Xu, HongLei Yi, Changrong Zhu, QingShui Ying

Published in: International Orthopaedics | Issue 1/2023

Abstract

Objective

Investigate a novel method for treating irreducible atlantoaxial dislocation (IAAD) or with basilar invagination (BI) by bony deformity osteotomy, remodeling, releasing, and plate fixating through transoral approach.

Method

From March 2015 to December 2019, 213 consecutive patients diagnosed as IAAD/BI were treated with transoral bony deformity remodeling and releasing combined with plate fixation. The main clinical symptoms include neck pain, headache, numbness of the limbs, weakness, unstable walking, inflexible hand-held objects, and sphincter dysfunction. The bony factors that impact reduction were divided into as follows: type A1 (sloping of upper facet joint in C2), type A2 (osteophyte in lateral mass joints between C1 and C2), type A3 (ball-and-socket deformity of lateral mass joint), type A4 (vertical interlocking between lateral mass joints of C1–C2), type A5 (regional bone fusion in lateral mass joints), type B1 (bony factor hindering reduction between the atlas-dens gap), type B2 (uncinate odontoid deformity), and type B3 (hypertrophic odontoid deformity). All of them were treated with bony deformity osteotomy, remodeling, and releasing techs.

Result

The operation time was 144 \(\pm\) 25 min with blood loss of 102 \(\pm\) 35 ml. The average pre-operative ADI improved from 7.5 \(\pm\) 3.2 mm pre-surgery to 2.5 \(\pm\) 1.5 mm post-surgery (p < 0.05). The average VDI improved from 12.3 \(\pm\) 4.8 mm pre-surgery to 3.3 \(\pm\) 2.1 mm post-surgery (p < 0.05). The average pre-operative CMA improved from 115 \(\pm\) 25° pre-surgery to 158 \(\pm\) 21° post-surgery (p < 0.05); the pre-operative CAA changed from 101 \(\pm\) 28° pre-surgery to 141 \(\pm\) 10° post-surgery. After the operation, the clinic symptoms improved, and the JOA score improved from 9.3 \(\pm\) 2.8 pre-operatively to 13.8 \(\pm\) 2.5 in the sixth months of follow-up.

Conclusion

In addition to soft tissue factors, bony obstruction was another important factor impeding atlantoaxial reduction. Transoral bony deformity osteotomy, remodeling, releasing combined with plate fixating was effective in treating IAAD/BI with bony obstruction factors.

Wang S, Wang C, Yan M, Zhou H, Dang G (2013) Novel surgical classification and treatment strategy for atlantoaxial dislocations[J]. Spine (Phila Pa 1976) 38(21):E1348–E1356CrossRef

Mingsheng T, Long G, Ping Y, Feng Y, Xiangsheng T, Haoning M, Qinying H (2020) New classification and its value evaluation for atlantoaxial dislocation. Orthop Surg 12(4):1199–1204CrossRef

Xu J, Yin Q, Xia H, Wu Z, Ma X, Zhang K, Wang Z, Yang J, Ai F, Wang J, Liu J, Mai X (2013) New clinical classification system for atlantoaxial dislocation. Orthopedics 36(1):e95-100CrossRef

Yang SY, Boniello AJ, Poorman CE, Chang AL, Wang S, Passias PG (2014) A review of the diagnosis and treatment of atlantoaxial dislocations. Global Spine J 4(3):197–210CrossRef

Behari S, Bhargava V, Nayak S, Kiran Kumar MV, Banerji D, Chhabra DK, Jain VK (2002) Congenital reducible atlantoaxial dislocation: classification and surgical considerations. Acta Neurochir (Wien) 144(11):1165–77CrossRef

Yin QS, Wang JH (2015) Current trends in management of atlantoaxial dislocation. Orthop Surg 7(3):189–199CrossRef

Liu T, Li F, Xiong W, Du X, Fang Z, Shang H, Chen A (2010) Video-assisted anterior transcervical approach for the reduction of irreducible atlantoaxial dislocation. Spine (Phila Pa 1976) 35(15):1495–501CrossRef

Ren X, Gao F, Li S, Yang J, Xi Y (2019) Treatment of irreducible atlantoaxial dislocation using one-stage retropharyngeal release and posterior reduction. J Orthop Surg (Hong Kong) 27(3):2309499019870465CrossRef

Kingdom TT, Nockels RP, Kaplan MJ (1995) Transoral-transpharyngeal approach to the craniocervical junction. Otolaryngol Head Neck Surg 113(4):393–400CrossRef

10.

Yin QS, Ai FZ, Zhang K, Mai XH, Xia H, Wu ZH (2010) Transoral atlantoaxial reduction plate internal fixation for the treatment of irreducible atlantoaxial dislocation: a 2- to 4-year follow-up. Orthop Surg 2(2):149–155CrossRef

11.

Xia H, Yin Q, Ai F, Ma X, Wang J, Wu Z, Zhang K, Liu J, Xu J (2014) Treatment of basilar invagination with atlantoaxial dislocation: atlantoaxial joint distraction and fixation with transoral atlantoaxial reduction plate (TARP) without odontoidectomy. Eur Spine J 23(8):1648–1655CrossRef

12.

Zou X, Ouyang B, Yang H, Wang B, Ge S, Chen Y, Ni L, Zhang S, Xia H, Yang J, Ma X (2020) Surgical treatment for basilar invagination with irreducible atlantoaxial dislocation: transoral atlantoaxial reduction plate fixation vs occipitocervical fixation. BMC Musculoskelet Disord 21(1):825CrossRef

13.

Yin Q, Ai F, Zhang K, Chang Y, Xia H, Wu Z, Quan R, Mai X, Liu J (2005) 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) 30(13):E375-81CrossRef

14.

Srivastava SK, Aggarwal RA, Nemade PS, Bhosale SK (2016) Single-stage anterior release and posterior instrumented fusion for irreducible atlantoaxial dislocation with basilar invagination. Spine J 16(1):1–9CrossRef

15.

Wang Q, Mao K, Wang C, Mei W (2017) Transoral atlantoaxial release and posterior reduction by occipitocervical plate fixation for the treatment of basilar invagination with irreducible atlantoaxial dislocation. J Neurol Surg A Cent Eur Neurosurg 78(4):313–320CrossRef

16.

Hao D, He B, Zheng Y, Zhang Z (2016) Single-stage anterior release and sequential posterior fusion for irreducible atlantoaxial dislocation. Clin Spine Surg 29(5):E240-5CrossRef

17.

Hao DJ, He BR, Wu QN (2009) One-stage anterior release and reduction with posterior fusion for treatment of irreducible atlantoaxial dislocation. Orthop Surg 1(4):305–10CrossRef

18.

Ma H, Dong L, Liu C, Yi P, Yang F, Tang X, Tan M (2016) Modified technique of transoral release in one-stage anterior release and posterior reduction for irreducible atlantoaxial dislocation. J Orthop Sci 21(1):7–12CrossRef

19.

Wang C, Yan M, Zhou HT, Wang SL, Dang GT (2006) Open reduction of irreducible atlantoaxial dislocation by transoral anterior atlantoaxial release and posterior internal fixation. Spine 31(11):E30606lanCrossRef

20.

Ma F, He H, Liao Y, Tang Q, Tang C, Yang S, Wang Q, Zhong D (2020) Classification of the facets of lateral atlantoaxial joints in patients with congenital atlantoaxial dislocation. Eur Spine J 29(11):2769–2777CrossRef

21.

Salunke P, Sharma M, Sodhi HB et al (2011) Congenital atlantoaxial dislocation: a dynamic process and role of facets in irreducibility[J]. J Neurosurg Spine 15(6):678–685CrossRef

22.

Yin YH, Yu XG, Zhou DB et al (2012) Three-dimensional configuration and morphometric analysis of the lateral atlantoaxial articulation in congenital anomaly with occipitalization of the atlas[J]. Spine (Phila Pa 1976) 37(3):E170–E173CrossRef

23.

Yin YH, Yu XG (2015) The severity of basilar invagination and atlantoaxial dislocation correlates with sagittal joint inclination, coronal joint inclination, and craniocervical tilt: a description of new indices for the craniovertebral junction[J]. Neurosurgery 76(2):E233–E235CrossRef

24.

Sarat Chandra P, Bajaj J, Singh PK, Garg K, Agarwal D (2019) Basilar invagination and atlantoaxial dislocation: reduction, deformity correction and realignment using the DCER (distraction, compression, extension, and reduction) technique with customized instrumentation and implants. Neurospine 16(2):231–250CrossRef

25.

Chandra PS, Prabhu M, Goyal N, Garg A, Chauhan A, Sharma BS (2015) Distraction, compression, extension, and reduction combined with joint remodelling and extra-articular distraction: description of 2 new modifications for its application in basilar invagination and atlantoaxial dislocation: prospective study in 79 cases. Neurosurgery 77(1):67–80 (discussion 80)CrossRef

26.

Laheri V, Chaudhary K, Rathod A, Bapat M (2015) Anterior transoral attlantoaxial release and posterior instrumented fusion for irreducible congenital basilar invagination. Eur spine J 24(12):2977–2985CrossRef

27.

Yuan SL, Xu HM, Fu LC, Cao J, Yang JK, Xi YM (2018) Sagittal atlantoaxial joint inclination and reduction index values for diagnosis and treatment of irreducible atlantoaxial dislocation. Indian J Orthop 52(2):190–195

28.

Chandra PS, Goyal N, Chauhan A, Ansari A, Sharma BS, Garg A (2014) The severity of basilar invagination and atlantoaxial dislocation correlates with sagittal joint inclination, coronal joint inclination, and craniocervical tilt: a description of new indexes for the craniovertebral junction. Neurosurgery 10(Suppl 4):621–629

29.

Hong Lee SW, Son BC et al (2008) Analysis of anatomical variations of bone and vascular structures around the posterior atlantal arch using three-dimensional computed tomography angiography [J]. J Neurosurg Spine 8(3):230–236CrossRef

30.

Xu S, Ruan S, Song X, Yu J, Xu J, Gong R (2018) Evaluation of vertebral artery anomaly in basilar invagination and prevention of vascular injury during surgical intervention: CTA features and analysis. Eur Spine J 27:1286lurnalCrossRef

31.

Yamazaki M, Okawa A, Furuya T, Sakuma T, Takahashi H, Kato K, Fujiyoshi T, Mannoji C, Takahashi K, Koda M (2012) Anomalous vertebral arteries in the extra- and intraosseous regions of the craniovertebral junction visualized by 3-dimensional computed tomographic angiography: analysis of 100 consecutive surgical cases and review of the literature. Spine 37:1389ureCrossRef

32.

Wang J, Xia H, Ying Q et al (2013) An anatomic consideration of C2 vertebrae artery groove variation for individual screw implantation in axis. Eur Spine J 22(4):154747 15

33.

Yin Q, Xia H, Wu Z, Ma X, Ai F, Zhang K, Wang J, Zhang T, Bai Z, Wang Z (2016) Surgical site infections following the transoral approach: a review of 172 consecutive cases. Clin Spine Surg 29:E502SurgSCrossRef

Title: Treatment of irreducible atlantoaxial dislocation by bony deformity osteotomy, remodeling, releasing, and plate fixating through transoral approach
Authors: Jianhua Wang
Hong Xia
Xiang yang Ma
Kai Zhang
SuoChao Fu
Qiang Tu
Junjie Xu
HongLei Yi
Changrong Zhu
QingShui Ying
Publication date: 04-11-2022
Publisher: Springer Berlin Heidelberg
Keywords: Computed Tomography
Computed Tomography
Invagination
Published in: International Orthopaedics / Issue 1/2023
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-022-05604-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Treatment of irreducible atlantoaxial dislocation by bony deformity osteotomy, remodeling, releasing, and plate fixating through transoral approach

Abstract

Objective

Method

Result

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Method

Result

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2023

Predictors of acute compartment syndrome in patients with tibial fractures: a meta-analysis

Methods of assessment of the level of surgeons for minimally invasive fixation of distal radius fractures: “expertise” versus “performance”

Landmark trials in orthopaedics — by Ashok N. Johari

Traumatic brain injuries are ignored or discriminated in prospective clinical trials on shoulder fractures: a systematic review

Enhanced recovery after surgery for primary total hip arthroplasty: analysis of post-operative blood indexes

Localization of osteomyelitis lesions for operative eradication of chronic osteomyelitis of the lower extremities by bone SPECT/CT: a feasibility study