Efficacy of pedicle screw technique in treatment of os odontoideum combined with atlantoaxial dislocation / 中华创伤杂志

ABSTRACT

ObjectiveTo evaluate the efficacy and radiological variation of pedicle screw technique in the treatment of os odontoideum combined with atlantoaxial dislocation.MethodsFifteen patients with os odontoideum combined with atlantoaxial dislocation were treated with occipitocervical fusion or atlantoaxial fixation.Two patients with irreducible atlantoaxial dislocation were treated surgically with transoral anterior atlantoaxial release and one treated with posterior arch removal plus occipitocervical fusion.Two patients with atlas deformity and one infant were treated with occipitocervical fusion.The rest patients were treated with posterior reduction and pedicle screw internal fixation.Clinical manifestations and imaging changes were followed up to evaluate the clinical efficacy.ResultsAll patients were followed-up for average 26 months (range,7-47 months).Neurological recovery was significantly improved in 13 patients and took a turn for the better in two.The average JOA scores was increased from average preoperative 8.27 to postoperative 15. According to Hirabayashi,the average improvement rate was77％,including 10 patients with excellent outcomes and five with good outcomes,with excellence rate of100％.The cervical-medullary angle was increased from average preoperative 130.3° to postoperative151.7°.Postoperative X-rays and CT showed good atlantoaxial alignment and solid bony fusion in all pa-tients,with no shedding or breakage of the fixators.ConclusionOccipitocervical fusion or adantoaxial fixation through pedicle screw technique is an effective method for treatment of os odontoideum combined with irreducible atlantoaxial dislocation.