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Journal of Orthopaedic Surgery and Research

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Open Access 01-12-2019 | Technical note

Endoscopic transnasal anterior release and posterior reduction without odontoidectomy for irreducible atlantoaxial dislocation

Authors: Xiangsheng Tang, Xinjie Wu, Mingsheng Tan, Ping Yi, Feng Yang, Qingying Hao

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2019

Abstract

Background

To investigate the efficacy and safety of endoscopic transnasal anterior release and posterior reduction without odontoidectomy to treat irreducible atlantoaxial dislocation (IAAD).

Methods

A series of 9 patients with IAAD underwent endoscopic transnasal anterior release and posterior reduction without odontoidectomy. Etiology, instrumentation, fusion rate, and complications were documented. All patients were assessed clinically and radiologically for neurological recovery using the Japanese Orthopedic Association (JOA) score, atlantodontoid interval (ADI), and cervicomedullary angle (CMA).

Results

The mean age of the patients was 41.6 years, ranging from 14 to 60 years. Pathology showed os odontoideum in 3 patients, old traumatic dens fracture in 3 patients, occipitalization of C1 in 2 patients, and rheumatoid arthritis in 1 patient. Seven patients underwent C1–C2 pedicle screw fixations, and 2 patients required occipitocervical fixation. Eight cases resulted in complete reduction and 1 in partial reduction. Complications included one superficial infection related to the posterior approach. All patients were followed up for an average of 17 (range 13–32) months. Bony fusion was confirmed in all cases under radiologic assessment at 1 year postoperatively, and the bony fusion rate reached 100%. Moreover, no instrumental failure occurred during the entire follow-up period. The JOA score improved from 7.21 ± 1.62 to 12.28 ± 0.81 at the last follow-up. The ADI of 9 cases was 7.06 ± 0.85 mm preoperatively, which decreased to 2.26 ± 0.56 mm at the final follow-up. CMA improved from 103.80° ± 4.16° to 143.23° ± 7.47° postoperatively.

Conclusion

With transnasal approach and lack of odontoidectomy, this method could not only treat IAAD safely and effectively, but also reduce the possibility of many complications associated with the traditional transoral approach and odontoidectomy.

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Title: Endoscopic transnasal anterior release and posterior reduction without odontoidectomy for irreducible atlantoaxial dislocation
Authors: Xiangsheng Tang
Xinjie Wu
Mingsheng Tan
Ping Yi
Feng Yang
Qingying Hao
Publication date: 01-12-2019
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2019
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-019-1167-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Endoscopic transnasal anterior release and posterior reduction without odontoidectomy for irreducible atlantoaxial dislocation

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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