Anterior release without odontoidectomy for irreducible atlantoaxial dislocation: transoral or endoscopic transnasal?

Dong, Chunke; Yang, Feng; Wei, Hongyu; Tan, Mingsheng

doi:10.1007/s00586-020-06527-z

Cited by 8 publications

(8 citation statements)

References 34 publications

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“…Although a variety of surgical methods, the choice of surgical methods is mainly based on the surgeon's clinical experience (23). Meanwhile, anterior release is also controversial (15). As far as we know, there was few research on the objective criteria for the selection of surgical methods for atlantoaxial dislocation.…”

Section: Discussionmentioning

confidence: 99%

The clinical validity of atlantoaxial joint inclination angle and reduction index for atlantoaxial dislocation

Yang

Du²,

Zhao³

et al. 2023

Front. Surg.

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ObjectiveAtlantoaxial dislocation patients with neurological defects require surgery. Sometimes, release surgery is necessary for irreducible atlantoaxial dislocation to further achieve reduction. Whether release surgery is essential relies on the surgeon's experience and lacks objective reference criteria. To evaluate the value of atlantoaxial joint inclination angle (AAJI) in sagittal and coronal planes and reduction index (RI) in the surgical approach selection for atlantoaxial dislocation.MethodsRetrospectively analyzed 87 cases (42 males and 45 females, 9–89 years) of atlantoaxial dislocation from January 2011 to November 2020. In addition, 40 individuals without atlantoaxial dislocation were selected as the control group. Imaging parameters were compared between the two groups. According to surgical methods, the experiment group was divided into two groups including Group A(release surgery group) and Group B (conventional operation group). The parameters were measured based on CT and x-ray. The relevant imaging parameters and clinical scores, including the AAJI in sagittal and coronal planes, the atlas-dens interval (ADI) before and after traction, the RI, and JOA scores were measured and analyzed.ResultsThe sagittal and coronal atlantoaxial joint inclination angles(SAAJI and CAAJI) in the control group were 7.91 ± 0.42(L), 7.99 ± 0.39°(R), 12.92 ± 0.41°(L), 12.97 ± 0.37°(R), in A were 28.94 ± 1.46°(L), 28.57 ± 1.55°(R), 27.41 ± 1.29°(L), 27.84 ± 1.55°(R), and in B were 16.16 ± 0.95°(L), 16.80 ± 1.00°(R), 24.60 ± 0.84°(L), 24.92 ± 0.93°(R) respectively. Statistical analysis showed that there was a statistical difference in the SAAJI between the control group and the experiment group (P < 0.01), as well as between groups A and B (P < 0.01). The RI in groups A and B was 27.78 ± 1.46% and 48.60 ± 1.22% respectively, and there was also a significant difference between the two groups (P < 0.01). There was negative correlation between SAAJI and RI.ConclusionsThe SAAJI and RI can be used as objective imaging indexes to evaluate the reducibility of atlantoaxial dislocation. And these parameters could further guide the selection of surgery methods. When the RI is smaller than 48.60% and SAAJI is bigger than 28.94°, anterior release may be required.

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Section: Discussionmentioning

confidence: 99%

The clinical validity of atlantoaxial joint inclination angle and reduction index for atlantoaxial dislocation

Yang

Du²,

Zhao³

et al. 2023

Front. Surg.

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“…This is related to the long-term lack of systematic research and understanding of transoral bacteriology. To solve the above problems, especially to get more recognition and promotion of transoral approach from spine surgery professionals, we adopt a series of preoperative and intraoperative cleaning and disinfection measures [ 27 , 28 ] and further transform type II incision with relative bacteria in the posterior pharyngeal wall into typeIsterile incision through strict bacteriological evaluation research so as to ensure the safe and effective implementation of transoral internal fixation. Although the number of 20 patients enrolled in this experiment is comparatively small which requires further comprehensive and systematic experimental design and more follow-ups, the successful experience of surgery also reflects that strict preoperative and intraoperative cleaning and disinfection process is effective and safe.…”

Section: Discussionmentioning

confidence: 99%

“…spine surgery professionals, we adopt a series of preoperative and intraoperative cleaning and disinfection measures [27,28] and further transform type II incision with relative bacteria in the posterior pharyngeal wall into typeIsterile incision through strict bacteriological evaluation research so as to ensure the safe and effective n) demonstrate that there is no significant compression of cervical spinal cord at atlantoaxial level, and no significant changes in partial degeneration of spinal cord. X-rays (see o and p) conducted 3 months after the operation show that the internal screw fixed in the atlantoaxial segment is in place without obvious loosening or displacement.…”

Section: Streptococcus Constellatusmentioning

confidence: 99%

Research on pharyngeal bacterial flora in transoral atlantoaxial operation and the postoperative follow-up study

You

Zhou

et al. 2022

BMC Musculoskelet Disord

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Objectives To study the changes of bacterial flora after a series of preoperative oral disinfection and the postoperative recovery of nerve function of patients with craniovertebral junction disorders who were treated with transoral approach operations. Methods This research analyzed 20 cases collected from October 2009 to May 2010. All these patients were with CVJ disorders, including 8 males and 12 females, aged 2 to 66 (38.1 on average), and they were all treated with transoral approach operations. The mucosa samples of the posterior pharyngeal wall were sent for bacteria culture. These samples were collected by sterile cotton swabs at four crucial points, including 3 days before operation/before gargling, 3 days after continuous gargling/after anesthesia intubation on the day of operation, after intraoperative cleaning and washing of the mouth, and after intraoperative iodophor immersion. The microflora was stained by means of smear and further counted after an investigation by microscope. The neural function of patients was evaluated by the ASIA classification and the JOA scores. All patients but two with posterior stabilization performed respectively underwent transoral atlantoaxial reduction plate (TARP) fixation consecutively in the same sitting. A regular reexamination of cervical vertebra with lateral and open mouth X-ray, CT and MRI was conducted after operation to evaluate the reduction of atlantoaxial dislocation, internal fixation position, bone graft fusion, inflammatory lesions and tumor recurrence. Results This bacteriological research showed that the mucosa of the posterior pharyngeal wall of all the patients was in a sterile state after a series of oral preoperative preparations and intraoperative iodophor disinfection, which was considered as type I incision. The bacterial culture results of the mucosa samples of the posterior pharyngeal wall collected at different time points showed significant differences (χ2 = 42.762, P = 0.000). All the patients had improvement in ASIA, and their neural functions were improved to different levels after operation. There was a significant difference in JOA scores before and after operation (t = 8.677, P = 0.000). Postoperative imaging examination showed that the atlantoaxial screw position was good and firm, and the CVJ disorders were treated appropriately. Conclusion It is safe and effective to cut the posterior pharyngeal muscle layer and implant internal fixation by means of transoral approach.

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“…Also, for patients with irreducible atlantoaxial dislocation, the anterior release is considered essential to achieve the reduction. However, traditional transoral approach is accompanied by many inevitable disadvantages, such as a narrow and unclear surgical field, difficult operative procedures, postoperative throat discomfort, and high-risk postoperative infection 13 . Besides, the transoral approach is not suitable for irreducible atlantoaxial dislocation patients with limited opening range of oral cavity or oral disease.…”

Section: Introductionmentioning

confidence: 99%

Retropharyngeal Reduction Plate for Atlantoaxial Dislocation: A Cadaveric Test and Morphometric Trajectory Analysis

Meng

et al. 2022

Orthopaedic Surgery

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Objective: To evaluate the placement feasibility and safety of the newly designed retropharyngeal reduction plate by cadaveric test and to perform morphometric trajectory analysis. Methods:The five cadaveric specimens with intact atlantoaxial joint were enrolled in this study. They were used for simulating the placement process and evaluating the placement feasibility of the retropharyngeal reduction plate. The atlantoaxial dislocation (AAD) of five cadaveric specimens were obtained by proper external force after dissecting ligaments. The retropharyngeal reduction plate was placed on atlantoaxial joint of cadaveric specimens. The X-ray and three-dimensional (3D) spiral CT were used for evaluating the placement safety of retropharyngeal reduction plate. The DICOM data was obtained after 3D spiral CT scanning for the morphometric trajectory analysis. Results:The reduction plates were successfully placed on the atlantoaxial joint of five cadaveric specimens through the retropharyngeal approach, respectively. The X-ray and 3D spiral CT showed the accurate screw implantation and satisfying plate placement. The length of the left/right atlas screw trajectory (L/RAT) was, respectively, 1.73 AE 0.01 cm (LAT) and 1.71 AE 0.02 cm (RAT). The length of odontoid screw trajectory (OST) was 1.38 AE 0.02 cm. The length of the left/right axis screw trajectory (L/RAXT) was, respectively, 1.67 AE 0.02 cm (LAXT) and 1.67 AE 0.01 cm (RAXT). There was no statistical significance between left side and right side in terms of AT and AXT (P > 0.05). The angles of atlas screw trajectory angle (ASTA), axis screw trajectory angle (AXSTA), and odontoid screw trajectory angle (OSTA) were 38.04

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Anterior release without odontoidectomy for irreducible atlantoaxial dislocation: transoral or endoscopic transnasal?

Cited by 8 publications

References 34 publications

The clinical validity of atlantoaxial joint inclination angle and reduction index for atlantoaxial dislocation

The clinical validity of atlantoaxial joint inclination angle and reduction index for atlantoaxial dislocation

Research on pharyngeal bacterial flora in transoral atlantoaxial operation and the postoperative follow-up study

Retropharyngeal Reduction Plate for Atlantoaxial Dislocation: A Cadaveric Test and Morphometric Trajectory Analysis

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