The operative methods and clinical observation for os odontoideum with atlantoaxial dislocation in children

English Keywords:Os odontoideum  Atlantoaxial dislocation  Internal fixation  Fusion  Children

English Abstract:

  【Abstract】 Objectives: To investigate the operative methods and clinical effects for os odontoideum with atlantoaxial dislocation in children. Methods: From January 2009 to January 2014, twelve patients with atlantoaxial dislocation secondary to os odontoideum were analyzed retrospectively. Seven patients with reducible alantoaxial dislocation were treated by posterior atlantoaxial fixation and fusion, 4 patients with irreducible alantoaxial dislocation were treated by combined transoral approach decompression and posterior bone fusion and C1-2 instrumentation, the other 1 patient with irreducible alantoaxial dislocation was treated by combined transoral approach decompression and posterior occipitocervical fusion. Clinical manifestations and imaging changes were followed up regularly. Results: All patients were followed up for an average of 28±15 months(range, 12-60 months). All patients gained significant improvement in clinical symptoms. Good flexion and extension function of the neck was achieved in the patients treated by short-segment fixation and fusion. 1 patient suffered from instrument broken and atlantoaxial dislocation 8 months after the operation, posterior approach revision was performed, and bony fusion was obtained after another 6 months. For the others, bony fusion was obtained at follow-up for an average of 6.0±2.5 months(range, 3-12 months). The average JOA score was improved from preoperative 9.6±1.4 points to 16.2±0.7 points at the final follow-up. Conclusions: Posterior internal fixation and fusion is a safe and effective method for the treatment of os odontoideum with atlantoaxial dislocation in children, and transoral approach release is necessary for those patients with irreducible alantoaxial dislocation and reducible alantoaxial dislocation but with consistent soft compression in front of spinal cord.