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European Spine Journal
Erschienen in: European Spine Journal 5/2019

02.01.2019 | Original Article

Effectiveness of posterior reduction and fixation in atlantoaxial dislocation: a retrospective cohort study of 135 patients with a treatment algorithm proposal

verfasst von: Jian Guan, Zan Chen, Hao Wu, Qingyu Yao, Qu Wang, Can Zhang, Tengfei Qi, Kai Wang, Wanru Duan, Jun Gao, Yongning Li, Fengzeng Jian

Erschienen in: European Spine Journal | Ausgabe 5/2019

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Abstract

Purpose

Surgical procedures on atlantoaxial dislocation remain controversial. The aim of this observational retrospective study was to investigate the treatment algorithm of surgical procedures.

Methods

According to CT and intraoperative evaluation during direct posterior reduction, 135 AAD cases were categorized into three groups: Group I: reducible dislocation; Group II: irreducible dislocation (Group IIa: effective decompression achieved after posterior reduction; Group IIb: no effective decompression after posterior reduction); and Group III: fixed dislocation. Group III presented with extensive bony fusions. Group I and Group IIa were treated with direct posterior reduction and fixation. Group IIb underwent posterior fixation and transoral odontoidectomy. Group III underwent transoral odontoidectomy alone. Japanese Orthopedic Association scores (JOA) were assessed to evaluate clinical status before and 6, 12 months after surgery.

Results

Our study included 118 Group I cases, 16 Group II cases (Group IIa: 11 cases; Group IIb: 5 cases), and one Group III case. Follow-up ranged from 12 to 36 months. Primary outcome: Anatomic atlantoaxial reduction was achieved in 118 of 135 patients (87.4%). Clinical improvements were seen in 96.3% (130/135) all the patients. Solid atlantoaxial fusion was shown in 134 patients. Secondary outcome: The overall complication rate was 3.7% (5/135). For Group I, the mean postoperative 6-month JOA was 14.5 versus 12.2 in preoperative patients (paired Student’s t test, P < 0.01).

Conclusions

This article proposes a clinical procedure that assists with therapeutic decision making and indicates the severity and difficulty of reduction of the atlantoaxial joint.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.
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Metadaten
Titel
Effectiveness of posterior reduction and fixation in atlantoaxial dislocation: a retrospective cohort study of 135 patients with a treatment algorithm proposal
verfasst von
Jian Guan
Zan Chen
Hao Wu
Qingyu Yao
Qu Wang
Can Zhang
Tengfei Qi
Kai Wang
Wanru Duan
Jun Gao
Yongning Li
Fengzeng Jian
Publikationsdatum
02.01.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
European Spine Journal / Ausgabe 5/2019
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-018-05869-z

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