Reduction by C1 lateral mass as well as C2 pedicle screw fixation and Mayfield skull traction for obsolete atlantoaxial dislocation

English Keywords:Atlantoaxial dislocation  Reduction  Lateral mass screws  Pedicle screw  Mayfield skull traction

English Abstract:

  【Abstract】 Objectives: To investigate the clinical outcome of reduction by C1 lateral mass as well as C2 pedicle screw fixation and Mayfield skull traction for obsolete atlantoaxial dislocation. Methods: The inclusive criteria was the range of motion of atlantoaxial facet joint≥5° on dynamic radiographs. A total of 11 patients undergoing posterior surgical reduction by C1 lateral mass and C2 pedicle screw placement following Mayfield skull traction from July 2008 to July 2011 were reviewed retrospectively. There were 7 males and 4 females with a mean age of 35.6 years(range, 28-55 years). Mayfield skull traction was performed in all patients. After screws were placed in C1-2, axial compression of C1-2 and forward pushing of C2-3 spinal process was applied to achieve reduction, after reduction, C1-2 autogenic bony graft was performed. VAS and JOA score was respectively used to evaluate the axial neck pain and the neurological deficit, and the results were compared before and after operation. Bony fusion was observed by the midline sagittal CT images. Results: The average operation time was 2.8±1.2h, and the mean blood loss was 260±80ml. No intraoperative neurovascular injury was noted. All patients were followed up for 6-36 months, with an average of 23 months. The average VAS score at final follow-up(3.15±1.28) was significantly lower than that of preoperation(6.14±1.92)(P＜0.05).　The average JOA score at final follow-up(14.22±2.76) was significantly higher than that of preoperation(10.57±2.12)(P＜0.05). No loss of reduction or instrument failure was noted at final follow-up. Solid fusion was achieved in all 11 patients 6 months later. Conclusions: For cases with atlantoaxial dislocation and ROM of C1-2 facet ≥5°, C1 lateral mass and C2 pedicle screw fixation following Mayfield skull traction is reliable and effective.