Primary application of slim transoral anterior reduction plate in pediatric atlantoaxial dislocation through transoral approach

English Keywords:Slim transoral anterior reduction plate  Transoral approach  Atlantoaxial dislocation  Children

English Abstract:

  【Abstract】 Objectives: To investigate the feasibility and clinical outcomes of slim transoral anterior reduction plate(Slim-TARP) for pediatric atlantoaxial dislocation(AAD) by transoral release and reduction. Methods: From February 2016 to June 2017, 8 pedatric patients(4 females and 4 males), ages ranging from 7.2 to 15.3 yeas old, were included in the study. Among them, there were 3 cases with os odontoid, 3 cases with basilar invagination(BA), and 2 cases of rotationary AAD(RAAD). All the patients underwent TARP opeation (transoral reduction and fixation with plate) after the failure of conservative treatment. The complications such as vertebral artery injury, incision break, infection, dysphonia and dysphagia were recorded. The patients were followed up for 8 to 14 months(average, 11.5 months), AAD reduction and bone fusion were assessed by X-ray, CT and MRI scan images, clinical outcomes were evaluated by JOA scores. Results: All the 8 patients underwent Slim-TARP operation successfully without excessive bleeding, vertebral artery injury, spinal dysfunction or other complications. They were followed up for 8-14 months(average, 11.5 months), all the incisions on pharyngeal wall healed well form the 7th to the 10th day after surgery, except 1 patient who with polypus around the incision on the 3th month postoperatively which was removed by otolaryngologist under endoscopy. There was no incision break, infection, dysphonia or dysphagia. The postoperative X-ray, CT and MRI images showed good reduction in all patients, and solid bone fusion was obtained from 3 to 5.5 months(average, 4.4 months), JOA improved from 14.4 before surgery to 16.6 at the last followed up. Conclusions: The Slim-TARP through transoral approach is feasible in pediatric AAD with less complications and good outcomes.