Clinical study of use of transoralatlantoaxial lateral joint cage plus mini compressive cervical frame fixation for the treatment of irreducible atlantoaxial dislocation

English Keywords:Irreducible atlantoaxial dislocation  Atlanto-axial joint  Cage  C-JAWS

English Abstract:

  【Abstract】 Objectives: To evaluate the clinical use of transoralatlantoaxial lateral joint cage plus mini compressive cervical frame(C-JAWS) fixation for the treatment of irreducible atlantoaxial dislocation. Methods: Fourteen patients with irreducible atlantoaxial dislocation, including eight irreducible atlantoaxial dislocation, one old atlantoaxial dislocation after posterior procedure, four basilar invagination and one basilar invagination after posterior occipitocervical fusionwere treated with transoralatlantoaxial lateral joint cage implantation and C-JAWS fixation. American Spinal Cord Injury Association(ASIA) were used to evaluate the surgical outcome. Before operation, 9 patients were in grade D, and 5 cases were in grade E. Patients were followed up and performed X-ray and CT to estimate reduction, fixation, and fusion. Results: All operations were successfully performed without neurovascular injury. After operation, 1 patient with neck discomfort and 1 case with foreign body sensation in throat relieved after correspondent treatment. The incidence of neck pain and extremity anesthesia or asthenia of all cases decreased in different degree. According to ASIA grading system, 9 cases were in grade D, 3 cases improved from D to E after surgery, and other six cases remained no change postoperatively. 5 cases with E grade preoperatively got no change postoperatively. ASIA motor score improved from preoperative 68.1±9.7 to 91.7±6.6 after the surgery, the difference had statistical significance(t=-17.220, P=0.000). The patients were followed up for 3 to 18 months (average, 12.2±6.8 months). Solid bony fusion and no instrument displacement was found on X-ray and CT. Conclusions: Transoralatlantoaxial lateral joint cage fusion and C-JAWS fixation procedure is a effective and selectable surgical method for treating of irreducible atlantoaxial dislocation.