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European Spine Journal

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01-04-2015 | Original Article

Transoral anterior release, odontoid partial resection, and reduction with posterior fusion for the treatment of irreducible atlantoaxial dislocation caused by odontoid fracture malunion

Authors: Zheng-wei Xu, Tuan-jiang Liu, Bao-rong He, Hua Guo, Yong-hong Zheng, Ding-jun Hao

Published in: European Spine Journal | Issue 4/2015

Abstract

Purpose

Several techniques have been introduced to manage irreducible atlantoaxial dislocation (IAAD). However, no study has reported the surgical method for the management of IAAD caused by odontoid fracture malunion. This study aimed to introduce a surgical method of transoral anterior release, odontoid partial resection, and reduction with sequential posterior fusion for the treatment of IAAD caused by odontoid fracture malunion. We also evaluated the clinical efficacy of this surgery.

Methods

This study included seven cases of IAAD caused by odontoid fracture malunion, collected from January 2008 to January 2011. Anterior atlantoaxial release was performed through anterior transoral approach, followed by partial resection of the odontoid process. C1–C2 were then fixed through pedicle screws and rods, and then fused posteriorly by single stage. Neurologic status was evaluated using the Japanese Orthopaedic Association (JOA) scoring system.

Results

All seven patients had complete release, and satisfactory reduction. Bony fusion was seen in all patients postoperatively. The patients were followed up for an average of 19.6 months (ranged from 9 to 36 months). The average of patients JOA scores at the final follow-up was significantly higher than that of their preoperative scores. Furthermore, the average improvement in neurological function was 87.4 %. No screw loosening, implant migration or implant failures, atlantoaxial redislocation, or signs of instability were observed in any of the patients during the follow-up period.

Conclusions

Transoral anterior release, odontoid partial resection, and reduction combined with posterior fusion are effective, reliable, and safe procedures for the treatment of IAAD caused by odontoid fracture malunion.

Subin B, Liu JF, Marshall GJ, Huang HY, Ou JH, Xu GZ (1995) Transoral anterior decompression and fusion of chronic irreducible atlantoaxial dislocation with spinal cord compression. Spine 20:1233–1240PubMed

Ai FZ, Yin QS, Xu DC, Xia H, Wu ZH, Mai XH (2011) Transoral atlantoaxial reduction plate internal fixation with transoral transpedicular or articular mass screw of C2 for the treatment of irreducible atlantoaxial dislocation: two case reports. Spine 36:E556–E562CrossRefPubMed

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 2:149–155CrossRefPubMed

Hirabayashi K, Miyakawa J, Satomi K, Maruyama T, Wakano K (1981) Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine 6:354–364CrossRefPubMed

Hao D, He B, Zheng Y, Zhang Z (2013) Single stage anterior release and sequential posterior fusion for irreducible atlantoaxial dislocation. J Spinal Disord Tech. doi:10.1097/BSD.0b013e31826be885

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:E306–E313CrossRefPubMed

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 30:E375–E381CrossRefPubMed

Yang J, Ma X, Xia H, Wu Z, Ai F, Yin Q (2014) Transoral anterior revision surgeries for basilar invagination with irreducible atlantoaxial dislocation after posterior decompression: a retrospective study of 30 cases. Eur Spine J 23:1099–1108CrossRefPubMed

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

10.

Shaha AR, Johnson R, Miller J, Milhorat T (1993) Transoral-transpharyngeal approach to the upper cervical vertebrae. Am J Surg 166:336–340CrossRefPubMed

11.

Menezes AH (2005) Avoiding complications with transoral surgical procedures to the craniovertebral junction. Oper Tech Neurosurg 8:160–163CrossRef

12.

Frempong-Boadu AK, Faunce WA, Fessler RG (2002) Endoscopically assisted transoral-transpharyngeal approach to the craniovertebral junction. Neurosurgery 51:S2–S60CrossRef

13.

Jain V, Behari S, Banerji D, Bhargava V, Chhabra D (1999) Transoral decompression for craniovertebral osseous anomalies: perioperative management dilemmas. Neurol India 47:188PubMed

14.

Tuite GF, Veres R, Crockard HA, Sell D (1996) Pediatric transoral surgery: indications, complications, and long-term outcome. J Neurosurg 84:573–583CrossRefPubMed

15.

Zileli M, Cagli S (2002) Combined anterior and posterior approach for managing basilar invagination associated with type I Chiari malformation. J Spinal Disord Tech 15:284–289CrossRefPubMed

16.

Menezes AH, VanGilder JC (1988) Transoral-transpharyngeal approach to the anterior craniocervical junction: ten-year experience with 72 patients. J Neurosurg 69:895–903CrossRefPubMed

17.

Dickman CA, Locantro J, Fessler RG (1992) The influence of transoral odontoid resection on stability of the craniovertebral junction. J Neurosurg 77:525–530CrossRefPubMed

18.

Hao DJ, He BR, Wu QN (2009) One-stage anterior release and reduction with posterior fusion for treatment of irreducible atlantoaxial dislocation. Orthop Surg 1:305–310CrossRefPubMed

Title: Transoral anterior release, odontoid partial resection, and reduction with posterior fusion for the treatment of irreducible atlantoaxial dislocation caused by odontoid fracture malunion
Authors: Zheng-wei Xu
Tuan-jiang Liu
Bao-rong He
Hua Guo
Yong-hong Zheng
Ding-jun Hao
Publication date: 01-04-2015
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 4/2015
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-014-3747-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Transoral anterior release, odontoid partial resection, and reduction with posterior fusion for the treatment of irreducible atlantoaxial dislocation caused by odontoid fracture malunion

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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