Comparison of outcomes in the treatment of reducible atlantoaxial dislocation by C1-2 transarticular screws combined with C1 laminar hook versus C1 lateral mass with C2 pedicle screws

English Keywords:Atlantoaxial dislocation  Reducible  Atlantoaxial transarticular screws  C1 laminar hook  Pedicle screws

English Abstract:

  【Abstract】 Objectives: To compare the clinical curative effects of C1-2 transarticular screws combined with C1 laminar hook (screw-hook constructs) versus C1 lateral mass with C2 pedicle screws(screw-rod constructs) for the treatment of reducible atlantoaxial dislocation. Methods: From June 2006 to March 2012, 74 patients with reducible atlantoaxial dislocation treated with atlantoaxial fixation by C1-2 screw-hook constructs were reviewed retrospectively, and 63 patients treated by C1-2 screw-rod constructs were as control. The visual analog scale(VAS) score, ASIA impairment scale, neck stiffness, neck disability index(NDI), blood loss during operation and operation time were reviewed. At the last follow-up, the clinical efficacy between the two groups were compared with regard to bone fusion rate, VAS score, ASIA impairment scale, NDI, neck stiffness and patient satisfaction. Results: There was no statistical difference in age, sex ratio, preoperative VAS score, NDI, ASIA impairment scale or follow-up period between the two groups(P>0.05). The postoperative follow-up period of screw-hook constructs group was 76.3±14.0(48-110) months, the average operation time was 126.1±8.6min, blood loss was 207.8± 34.2ml, bone fusion rate was 100%, the average fusion time was 4.6±0.9 months. The postoperative follow-up period of screw-rod constructs group was 72.0±12.0(48-96) months, the average operation time was 129.8±7.9min, blood loss was 225.8±30.0ml, bone fusion rate was 98%, the average fusion time was 4.8±1.2 months. There was no statistical difference in the follow-up time, average operation time, bone graft fusion rate or average fusion time between the two groups(P＞0.05). There was a significant statistical difference in blood loss between the two groups(P<0.05). The ASIA impairment scale of 49 cases with neurological symptoms in screw-hook constructs group was improved by 1-2 grade, 37 cases in screw-rod constructs group with the same result. While VAS score, NDI and neck stiffness were decreased at the last follow-up in each group(P<0.05). There was no significant difference between the two groups with respect to VAS score, ASIA impairment scale, neck stiffness, patient satisfaction or NDI at the last follow-up(P＞0.05). Conclusions: Both screw-hook constructs and screw-rod constructs can achieve satisfactory clinical efficacy for reducible atlantoaxial dislocation, but screw-hook constructs group has less blood loss.