The value of cranial traction under general anesthesia in surgical selection for the atlantoaxial dislocation

English Keywords:Atlantoaxial dislocation  Cranial traction  Operative selection

English Abstract:

  【Abstract】 Objectives: To evaluate the feasibility of cranial traction under general anesthesia in surgical selection of atlantoaxial dislocation. Methods: Twenty-six patenits with atlantoaxial dislocation were treated from January 2008 to December 2015, including 18 males and 8 females, aging from 18 to 65 years with an average age of 45.0±5.6 years. All cases applied cranial traction after general anesthesia. After traction, patients who got reduction underwent posterior fixation and fusion, including atlantoaxial facet joint release, stick pre-bending, fixation distracting and so on. Patients who did not get reduction underwent transoral release combined with posterior fixation. Before and after operation the change of atlantodental interval(ADI) and clivus-axial angle were applied to evaluate the reduction. The change of JOA score and NDI score were applied to evaluate the symptom improvement before and after operation. Symon clinical standard was used to assessed total response after operation. Results: All the 26 patients were succesfully operated, among them 23 cases(88.5％) underwent posterior fixation and fusion, 3 cases(11.5％ ) who did not get reduction underwent aschose transoral release combined with posterior fixation and fusion. All patients were followed up from 6 months to 8 years(average, 25.3±6.3 months). The mean ADI, clivus-axial angle, JOA score and NDI score before and after operation were 7.4±1.5mm, 121.3°±5.1°, 8.0±0.9, 36.6±3.0 and 2.1±0.9mm, 143.7°±6.2°, 14.1±1.6, 15.7±5.6. The ADI, clivus-axial angle, JOA score and NDI score significantly improved compared to those before operation(P<0.05). Symon clinical standard got an effective rate of 96％ and excellence rate of 50％ at last follow-up. Conclusions: According to the reduction of atlantoaxial dislocation after cranial traction under general anaesthesia, choosing posterior fixation or anterior release combined with posterior approach can achieve good clinical efficacy.