Atlantoaxial joint release through anterior retrophayngeal approach and staged posterior reduction fixation and fusion for irreducible atlantoaxial dislocation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YUAN Yang ^1,2 , LEI Fei ³ ,  ZHOU Chunguang ¹ , LIU Limin ¹ , SONG Yueming ¹

1. Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
2. Department of Orthopaedics, the People’s Hospital of Pengzhou, Pengzhou Sichuan, 611930, P.R.China;
3. Department of Spinal Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;

Corresponding?author：

ZHOU Chunguang, Email: zhouchunguang@aliyun.com

Keywords：

Atlantoaxial dislocation; anterior retrophayngeal approach; anterior release; posterior fusion

DOI：

10.7507/1002-1892.201712121

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Objective To discuss the effectiveness of atlantoaxial joint release through anterior retrophayngeal approach and staged posterior reduction fixation and fusion for irreducible atlantoaxial dislocation (IAAD). Methods Fifteen patients with IAAD (9 males, 6 females), aged 14-53 years (mean, 31.4 years) were included in the study. The disease duration was 3 months to 17 years (mean, 5.7 years). IAAD was attributed to trauma in 13 cases, and 2 cases were caused by congenital odontoid disconnection. Preoperative imaging examination showed atlantoaxial dislocation and could not be reset automatically in functional position. The preoperative visual analogue scale (VAS) score was 3-7 (mean, 4.1), and the preoperative Japanese Orthopaedic Association (JOA) score was 10-17 (mean, 13.8). All patients received atlantoaxial joint release through anterior retrophayngeal approach and staged posterior fixation and fusion. Results Anatomical reduction was achieved in all 15 patients, and the alignment of atlantoaxial joints was restored. After operation, the neck pain and neurological symptom were partially or fully improved in all patients, without deterioration of neurological function. One patient developed pharyngeal discomfort and cough after one-stage operation, 4 patients developed pharyngeal discomfort and foreign body sensation after operation, and 2 patients developed pin-path lipstick swelling during skull traction. All patients were cured by symptomatic treatment. No pulmonary infection, pressure ulcers, venous thrombosis, and incision infection was found during the treatment. All 15 patients were followed up 24-36 months, with an average of 28.6 months. Bony fusion was achieved in all patients, and the fusion time was 3-5 months, with an average of 3.6 months. At last follow-up, the VAS score was 0-2 (mean, 0.5) and the JOA score was 13-17 (mean, 15.9). There was no dislocation, recurrence, or other abnormal sign in the cervical X-ray films and three-dimensional CT. Conclusion Anatomical reduction can be achieved by atlantoaxial joint release through anterior retrophayngeal approach and staged posterior fixation and fusion for treating IAAD. It is an optional procedure for IAAD.

Citation： YUAN Yang, LEI Fei, ZHOU Chunguang, LIU Limin, SONG Yueming. Atlantoaxial joint release through anterior retrophayngeal approach and staged posterior reduction fixation and fusion for irreducible atlantoaxial dislocation. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(11): 1377-1381. doi: 10.7507/1002-1892.201712121 Copy

1.	章凱, 王智運, 尹慶水. 難復型寰樞椎脫位經口咽入路手術治療進展. 中華創傷骨科雜志, 2006, 8(12): 1175-1179.
2.	黨耕町. 寰樞椎脫位的外科治療進展. 中華外科雜志, 2004, 42(1): 27-29.
3.	王超, 閻明, 周海濤, 等. 難復性寰樞關節脫位的手術治療. 中華骨科雜志, 2004, 24(5): 290-294.
4.	徐峰, 蔡賢華, 陳莊洪, 等. 一期前方咽后入路松解后路融合治療難復性寰樞椎脫位. 中國臨床神經外科雜志, 2011, 16(11): 656-659.
5.	陳琪, 宋躍明, 劉立岷, 等. 前后聯合入路治療陳舊性寰樞椎旋轉脫位合并側塊關節絞鎖. 中華骨科雜志, 2015, 35(5): 488-494.
6.	任先軍, 王衛東, 蔣濤. Ⅰ期前后路聯合手術治療游離齒突繼發的難復性寰樞椎脫位. 中國骨科臨床與基礎研究雜志, 2010, 2(3): 172-175.
7.	宋躍明. 難復性寰樞椎脫位的外科治療. 中國骨科臨床與基礎研究雜志, 2010, 2(3): 167-171.
8.	尹慶水, 劉景發, 夏虹, 等. 經口咽前、后路一期手術治療難復性寰樞椎脫位伴脊髓壓迫癥. 中國脊柱脊髓雜志, 2001, 11(2): 100-102.
9.	王超, 閻明, 周海濤, 等. 前路松解復位后路內固定治療難復性寰樞關節脫位. 中國脊柱脊髓雜志, 2003, 13(10): 583-586.
10.	莊青山, 夏德濤, 葛吉玉, 等. 經口咽前路松解復位后路椎弓根螺釘內固定治療難復性寰樞椎脫位. 中國脊柱脊髓雜志, 2009, 19(6): 427-430.
11.	Jones DC, Hayter JP, Vaugan ED, et al. Oropharyngereal morbility following transoral approaches to the upper cervical spine. Int J Maxillofac Surg, 1998, 27(4): 295-298.
12.	Hao D, He B, Zheng Y, et al. Single stage anterior release and sequential posterior fusion for irreducible atlantoaxial dislocation. Clin Spine Surg, 2016, 29(5): E240-245.
13.	閆明, 王超, 王圣林, 等. 經口咽入路寰樞關節松解復位術后發生的敗血癥 (附 4 例報道). 中國脊柱脊髓雜志, 2009, 19(12): 920-926.
14.	Fang HSY, Ong GB. Direct approach to the upper cervical spine. J Bone Joint Surg (Am), 1962, 44(8): 1588-1604.
15.	唐國軍, 萬煒. 難復性寰樞椎脫位的治療進展. 現代生物醫學進展, 2012, 12(30): 5957-5961.
16.	Park SH, Sung JK, Lee SH, et al. High anterior cervical approach to the upper cervical spine. Surg Neurol, 2007, 68(5): 519-524.
17.	Vender JR, Harrison SJ, McDonnell DE. Fusion and instrumentation at C1-3 via the high anterior cervical approach. J Neurosurg, 2000, 92(1 Suppl): 24-29.
18.	Richter MS, Schmidt R, Claes L, et al. Posterior atlantoaxial fixation: biomechanical in vitro comparison of six different echniques. Spine (Phila Pa 1976), 2002, 27(16): 1724-1732.

1. 章凱, 王智運, 尹慶水. 難復型寰樞椎脫位經口咽入路手術治療進展. 中華創傷骨科雜志, 2006, 8(12): 1175-1179.
2. 黨耕町. 寰樞椎脫位的外科治療進展. 中華外科雜志, 2004, 42(1): 27-29.
3. 王超, 閻明, 周海濤, 等. 難復性寰樞關節脫位的手術治療. 中華骨科雜志, 2004, 24(5): 290-294.
4. 徐峰, 蔡賢華, 陳莊洪, 等. 一期前方咽后入路松解后路融合治療難復性寰樞椎脫位. 中國臨床神經外科雜志, 2011, 16(11): 656-659.
5. 陳琪, 宋躍明, 劉立岷, 等. 前后聯合入路治療陳舊性寰樞椎旋轉脫位合并側塊關節絞鎖. 中華骨科雜志, 2015, 35(5): 488-494.
6. 任先軍, 王衛東, 蔣濤. Ⅰ期前后路聯合手術治療游離齒突繼發的難復性寰樞椎脫位. 中國骨科臨床與基礎研究雜志, 2010, 2(3): 172-175.
7. 宋躍明. 難復性寰樞椎脫位的外科治療. 中國骨科臨床與基礎研究雜志, 2010, 2(3): 167-171.
8. 尹慶水, 劉景發, 夏虹, 等. 經口咽前、后路一期手術治療難復性寰樞椎脫位伴脊髓壓迫癥. 中國脊柱脊髓雜志, 2001, 11(2): 100-102.
9. 王超, 閻明, 周海濤, 等. 前路松解復位后路內固定治療難復性寰樞關節脫位. 中國脊柱脊髓雜志, 2003, 13(10): 583-586.
10. 莊青山, 夏德濤, 葛吉玉, 等. 經口咽前路松解復位后路椎弓根螺釘內固定治療難復性寰樞椎脫位. 中國脊柱脊髓雜志, 2009, 19(6): 427-430.
11. Jones DC, Hayter JP, Vaugan ED, et al. Oropharyngereal morbility following transoral approaches to the upper cervical spine. Int J Maxillofac Surg, 1998, 27(4): 295-298.
12. Hao D, He B, Zheng Y, et al. Single stage anterior release and sequential posterior fusion for irreducible atlantoaxial dislocation. Clin Spine Surg, 2016, 29(5): E240-245.
13. 閆明, 王超, 王圣林, 等. 經口咽入路寰樞關節松解復位術后發生的敗血癥 (附 4 例報道). 中國脊柱脊髓雜志, 2009, 19(12): 920-926.
14. Fang HSY, Ong GB. Direct approach to the upper cervical spine. J Bone Joint Surg (Am), 1962, 44(8): 1588-1604.
15. 唐國軍, 萬煒. 難復性寰樞椎脫位的治療進展. 現代生物醫學進展, 2012, 12(30): 5957-5961.
16. Park SH, Sung JK, Lee SH, et al. High anterior cervical approach to the upper cervical spine. Surg Neurol, 2007, 68(5): 519-524.
17. Vender JR, Harrison SJ, McDonnell DE. Fusion and instrumentation at C1-3 via the high anterior cervical approach. J Neurosurg, 2000, 92(1 Suppl): 24-29.
18. Richter MS, Schmidt R, Claes L, et al. Posterior atlantoaxial fixation: biomechanical in vitro comparison of six different echniques. Spine (Phila Pa 1976), 2002, 27(16): 1724-1732.

Chinese Journal of Reparative and Reconstructive Surgery

Atlantoaxial joint release through anterior retrophayngeal approach and staged posterior reduction fixation and fusion for irreducible atlantoaxial dislocation

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