ABSTRACT
Objective:To evaluate the long-term outcomes of posterior release, reduction, fixation, and fusion for irreducible atlantoaxial dislocation (AAD).Methods:Between January 2005 and June 2016, a total of 31 patients with irreducible AAD who had received posterior approach surgery were included. Among them, there were 13 males and 18 females, the average age was 39.1±13.5 years (range 9-72 years). The clinical data of the eligible individuals were collected and analyzed. Neck disability index (NDI) and Japanese Orthopaedic Association (JOA) scores were recorded to evaluate the recovery of neck and neurological functions. The atlantodental interval (ADI), clivus-canal angle (CCA), and cervico-medullary angle (CMA) were measured to evaluate the reduction of AAD. C 0-C 2 angle and C 2-C 7 angle were measured to evaluate the recovery of cervical alignment. For individuals with basilar invagination, the distances from the tip of odontoid process to Chamberlain line and Wackenheim line were measured to assess the reduction in the vertical direction. The duration of bony fusion and complications were also analyzed. Results:The mean follow-up period was 82.7±26.4 months (range 61-170 months). In terms of functional scores, the NDI dropped from 43.41%±11.60% before surgery to 12.19%±6.97% at the six months follow-up, and 9.45%±7.51% at the last follow-up ( F=89.56, P<0.001). The JOA increased from 9.48±2.41 points before surgery to 14.71±1.42 points at the six months follow-up, and 14.97±1.47 points at the last follow-up ( F=52.89, P<0.001). Regarding the horizontal and vertical dislocations, the ADI decreased from 9.16±2.32 mm before surgery to 1.39±1.04 mm at the six months follow-up, and 1.29±1.08 mm at the last follow-up ( F=189.61, P<0.001). The distance from the tip of odontoid process to Chamberlain line decreased from 11.15±4.35 mm before surgery to 2.03±2.83 mm at the six months follow-up, and 2.15±3.02 mm at the last follow-up ( F=37.58, P<0.001). The distance from the tip of odontoid process to Wackenheim line reduced from 6.81±2.57 mm before surgery to -2.23±1.58 mm at the six months follow-up, and -2.27±1.58 mm at the last follow-up ( F=122.16, P<0.001). For the amelioration of the compression on medulla and spinal cord, the CCA increased from 113.68°±12.67° before surgery to 143.39°±7.38° at the six months follow-up, and 142.39°±7.13° at the last follow-up ( F=67.13, P<0.001). The CMA increased from 115.71°±13.69° before operation to 145.58°±10.78° at the last follow-up ( F=41.44, P<0.001). Regarding the curvature of the cervical spine, the C 0-C 2 angle recovered from 1.94°±15.82° before surgery to 14.84°±6.45° at the last follow-up ( F=11.97, P<0.001), and the C 2-C 7 angle ameliorated from 27.26°±8.49° before operation to 19.26°±5.44° at the last follow-up ( F=11.13, P<0.001). Bony fusion was achieved in all cases, the fusion time was 9.71±2.55 months (range 5-15 months). A total of five complications occurred in the cases (two cerebrospinal fluid leakages, one deep infection, one transient neurologic deficit, and one dysphagia). They were all cured with corresponding treatments. In the last follow-up, none of the cases developed failure of internal fixation or re-dislocation. Conclusion:Posterior approach release, reduction, fixation and fusion technique is a safe and efficient surgical strategy with favorable long-term follow-up outcomes for irreducible AAD.
ABSTRACT
Objective:To compare the clinical efficacy and complications of combined anterior and posterior approach and simple posterior release reduction and internal fixation in the treatment of basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD) .Methods:The medical records of 47 patients with basilar invaginationdepression complicated with refractory atlantoaxial dislocation who received surgical treatment from July 2000 to December 2017 were retrospectively analyzed. The patients were divided into anterior and posterior combined approach group (23 cases) and posterior approach group (24 cases). Key observation indicators include: Chamberlain line (CL), Wackenheim line (WL), McGae line (ML), atlantodens interval (ADI), cervicomedullary angle (CMA), clivus-canal angle (CCA), JOA scores (Japanese Orthopedic Association, JOA) and Ranawat grade.Results:The average follow-up was 48.7±31.2 months in the A-P group and 44.4±33.4 months in the P group. The average preoperative JOA score of the A-P group was 8.20±2.75 points and 14.98±1.05 points at the last follow-up, and the improvement rate was 77.35%±11.35%. The average preoperative JOA score of the P group was 8.06±2.52 points, and the last follow-up was 14.71±0.62 points, and the improvement rate was 74.38%±10.52%. There was no statistically significant difference between the two groups in JOA score ( t=0.877, P=0.262) and improvement rate ( t=1.478, P=0.206) at the last follow-up. The preoperative CL, WL, ML, ADI, CMA and CCA angles of the A-P group were 13.12±5.76 mm, 6.94±3.55 mm, 7.04±4.57 mm, 9.75±2.06 mm, 110.85°±13.6°, 95.32°±18.3°, respectively. The last follow-up was 1.68±2.53 mm, -2.76±2.26 mm,-1.52±2.43 mm, 1.12±1.55 mm, 149.26°±12.6°, and 141.42°±13.7°, respectively, with statistically significant differences from preoperative. The preoperative CL, WL, ML, ADI, CMA and CCA angles of P group were 12.52±5.17 mm, 6.59±3.04 mm, 6.94±4.32 mm, 9.88±1.93 mm, 115.35°±12.4°, 97.25°±16.4°, respectively. The results of the last follow-up were 2.00±3.67 mm, -3.06±1.85 mm, -1.76±2.88 mm, 1.17±1.18 mm, 146.76°±11.4° and 137.56°±10.4°, respectively, which were statistically significant compared with the preoperative results. There was no significant difference between the two groups in preoperative and final follow-up. The average bone graft fusion time of the A-P group was 9.2±4.9 months, and the average bone graft fusion time of the P group was 9.5±4.7 months. There was no statistically significant difference in the bone graft fusion time between the two groups ( t=0.547, P=0.382). Postoperative complications occurred in a total of 8 cases in the two groups, including 6 cases (21.7%) in the combined approach group and 2 cases (8.3%) in the posterior approach group. The incidence of complications in the posterior approach group was significantly lower than that in the combined approach group. Conclusion:The clinical and imaging results of the treatment of basilar depression with atlantoaxial dislocation by one-stage posterior release reduction and internal fixation are basically the same as those obtained by the anterior and posterior combined approach, but the complication rate of the posterior approach is significantly lower than that of the anterior and posterior combined approach.
ABSTRACT
Objective:To evaluated the indications, methods, outcomes and prognosis of surgical treatment for post-traumatic epiphyseolisthesis at odontoid process in children.Methods:Retrospective analysis was performed on 5 cases of children with delayed epiphyseolisthesis of odontoid process in our institution from July 2009 to October 2016, including 1 male and 4 females. Initial surgery age were at1.7~5.4 years old, averaged (39.6±19.4) months and were 0.67-8 months, averaged (87.0±95.1) days. Disease duration ranged from 23 days to 8 months, with an average of 88 days. X-ray, CT and MRI examinations of the occipital-cervical area were taken to evaluate the type of the fracture and the severity of spinal cord compression. Children were treated with anterior loosening combined with posterior fixation fusion or posterior loosening reduction and internal fixation respectively.The function of spinal cord was evaluated by Frankel scale at pre- and post- operation. During the follow-up, X-ray and CT were performed to assess the fusion condition of the grafted bone.Results:The duration of operation was ranged from 75-145 months, with an average of (101.0±20.7) months; Blood loss ranged from 50-100 ml, with an average of (70.0±21.2) ml; follow-up duration ranged from 6 to 48 months, with an average of (23.5±17.6) months. Two cases preoperatively evaluated as Frankel C and D recovered to postoperative Frankel E. Among the five cases, two received satisfactory reduction, two cases received incomplete reduction, and one experienced failure reduction. The epiphyseolisthesis and bone grafted sites achieved solid fusion at 6-15 months after surgery, with an average of (9.5±3.4) months. The physiological curvature of cervical remained well without bone resorption, nonunion, pseudoarthrosis, as well as screw loosening or broken. Internal fixation of 2 cases were removed.Conclusion:Children with post-traumatic epiphyseolisthesis at odontoid process are not common in clinical practice. The detailed diagnosis of medical history, physical examination and comprehensive imaging evaluation. The posterior approach technique of C1-2 was feasible and effective, which could obtain decompression, reconstruction andstability all together.
ABSTRACT
Objective To evaluate the clinical effects of a single posterior translaminal or transforaminal debridement and internal fixation with bone graft for the treatment of lumbosacral regional spinal tuberculosis. Methods From January 2004 to October 2009, 32 patients with lumbosacral regional spinal tuberculosis were treated by a single posterior debridement and internal fixation with bone graft, including 21 males and 11 females with the mean age of 46 years (range, 32-65). The lesions located: 3 in L3,4, 19 in L4,5, 10 in L5S1. 20 cases were pedormed operation via translaminal approach, 12 via transforaminal approach. The modified Prolo scale, visual analogue scale (VAS), kyphosis angle and the vertebral body loss were measured before and after surgery, and in the final follow-up. Results All the patients were followed up for average 16 months (range, 12-24). The pre-, postoperative and final follow-up mean kyphosis angle were -24.3°,-34.8°, and -32.4° in the translaminal group, -25.4°, -35.2°, and 33.6° in the transforaminal group,respectively. According to the modified Prolo scale, the excellent and good result was 93.8%. VAS decreased significantly from 7.6 points to 2.9 after surgery. Conclusion Debridement and internal fixation with bone graft via a single posterior approach for the treatment of lumbosacral regional spinal tuberculosis was an easy and effective technique. The appropriate selection of indications, careful imaging evaluation and thorough surgical debridement played an important role in the treatment of lumbosacral regional spinal tuberculosis.