Individualized treatment of tuberculous atlantoaxial dislocation: 12 cases reports

English Keywords:Atlantoaxial dislocation  Spinal tuberculosis  Surgical treatment  JOA score  NDI score

English Abstract:

  【Abstract】 Objectives: To explore the feasibility and effectiveness of individualized surgical approach for tuberculous atlantoaxial dislocation. Methods: A retrospective analysis was performed on the clinical data of 12 patients with tuberculous atlantoaxial dislocation who were treated at our hospital between January 2018 and November 2023. The cohort consisted of 7 males and 5 females, aged 27 to 79 years. Preoperative neurological status according to the Frankel grading system was grade C in 2 cases, grade D in 7 cases, and grade E in 3 cases. All patients received a four-drug antituberculosis regimen for 2 weeks preoperatively and 18 months postoperatively. The surgical approach was individualized based on neurological function and imaging findings, as follows: (1) a standalone anterior approach was adopted when severe destruction of the pedicles and lateral masses of the atlas and axis was present; (2) a combined anterior-posterior approach was employed when anterior soft tissue destruction was extensive while the osseous structures of the atlas and axis remained relatively intact; and (3) a standalone posterior approach was selected when anterior soft tissue destruction was mild and the atlantoaxial osseous structures were relatively well preserved. Clinical outcomes were assessed using the Frankel grade, Japanese Orthopaedic Association(JOA) score, and neck disability index(NDI) before operation and at final follow-up. Radiological evaluation for cervical stability and spinal cord compression was performed using the atlanto-dental interval(ADI) and the cervicomedullary angle(CMA). Results: Neurological function improved significantly after surgery. According to the Frankel grading system, 2 cases improved from grade C to D, and 7 cases improved from grade D to E. The mean JOA score increased from 11.5 preoperatively to 15.5 postoperatively(P<0.05), while the mean NDI score decreased from 37.8 to 9.2(P<0.05). Radiologically, the mean CMA increased from 134.7° to 157.7°(P<0.05), and the mean ADI decreased from 5.1mm preoperatively to 1.7mm postoperatively(P<0.05). Complications included dysphagia in one case and donor site pain in one case. During follow-up, no recurrence of tuberculous lesions, redislocation, or loosening or displacement of internal fixation was observed. Successful bone graft fusion was achieved in all patients within 3 to 9 months after surgery. Conclusions: Individualized surgical strategy effectively clears tuberculous lesions, restores atlantoaxial alignment and stability, and leads to significant improvement in neurological function. It therefore represents a reliable treatment option for tuberculous atlantoaxial dislocation.