Bone Grafting of Atlantoaxial Joints and Occipitocervical or Atlantoaxial Fusion for the Reduction and Fixation of Basilar Invagination with Atlantoaxial Dislocation by a Posterior Approach: A Preliminary Study

He, Xin; Meng, Yibin; Zhang, Jianan; Hang, Yunfei; Yang, Jun-Song; Wu, Qin; Hao, Dingjun

doi:10.1016/j.wneu.2016.12.131

Cited by 7 publications

(6 citation statements)

References 26 publications

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“…The removal of cartilage and roughing up of the atlantoaxial joints bilaterally provide an ideal environment for postoperative fusion. Besides, the contact area of the bone‐graft bed in the atlantoaxial joints is large enough for the placement of bone autograft, which make it more conducive to the fusion of the autograft 5,29,30 . Additionally, the bone autograft acts as a stimulus for living bone growth and maintains structural strength immediately.…”

Section: Discussionmentioning

confidence: 99%

“…Besides, the contact area of the bone‐graft bed in the atlantoaxial joints is large enough for the placement of bone autograft, which make it more conducive to the fusion of the autograft. 5 , 29 , 30 Additionally, the bone autograft acts as a stimulus for living bone growth and maintains structural strength immediately. So, careful preparation of the surfaces of the atlas and cervical vertebrae should be performed to promote the fusion process.…”

Section: Discussionmentioning

confidence: 99%

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Early Outcomes of Bone Autografting in the Bilateral Atlantoaxial Joints Applied in Posterior Fusion Surgery

Wang,

Liu,

Wang

et al. 2024

Orthopaedic Surgery

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ObjectiveCable‐dragged reduction and cantilever beam internal fixation can provide promising results in the treatment of atlantoaxial dislocation or instability. However, bilateral atlantoaxial joints bone autografting has not been conducted in this technique. We aim to evaluate the safety and effectiveness of bilateral atlantoaxial joints bone autografting in posterior cable‐dragged reduction and cantilever‐beam internal fixation.MethodsIn this retrospective study, we included 14 patients with a minimum 24‐month follow‐up from December 2019 to September 2020. The granular bone harvested from the iliac crest was packed into the bilateral atlantoaxial joints of 14 patients in posterior cable‐dragged reduction and cantilever‐beam internal fixation. X‐ray imaging and cervical computed tomography (CT) were performed during follow‐up. The time required for bone fusion was recorded. The clinical outcomes were evaluated using the JOA scores, NDI, and VAS scores. Mann–Whitney U test, the chi‐squared test, or the Fisher exact test were used to compare the two groups regarding patient characteristics, clinical outcomes, bone fusion rates, and cervical sagittal alignment.ResultsThe operations were successfully performed in all patients without any intraoperative complications. The mean operation time was (169.64 ± 20.91) minutes, and the intraoperative blood loss was (130.71 ± 33.62) mL. All patients received satisfactory reductions and firm bony fusion at the final follow‐up. The fusion rates were 64.29% in the atlantoaxial joints and 21.43% in post bone graft area at 3 months postoperatively, and a significant difference was observed (p = 0.022). Besides, the cervical sagittal alignment in all patients was well maintained in the last follow‐up compared to preoperatively. Importantly, a complete bony fusion in the atlantoaxial joints was observed in all patients. Moreover, the JOA, NDI, and VAS scores had improved significantly at the last follow‐up.ConclusionBone autografting of the bilateral atlantoaxial joints is a safe and effective technique to increase bone fusion rates, shorten bone fusion time, and reduce complication rates when the cable‐dragged reduction and cantilever beam internal fixation approach is used. Therefore, it is a cost‐effective surgical procedure for treating patients with atlantoaxial dislocation or instability.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Early Outcomes of Bone Autografting in the Bilateral Atlantoaxial Joints Applied in Posterior Fusion Surgery

Wang,

Liu,

Wang

et al. 2024

Orthopaedic Surgery

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“…There are a variety of surgical schemes for the treatment of BI, through oropharyngeal approach release and reduction combined with posterior fusion fixation 20 , endoscopic odontoidectomy combined with posterior reduction and fixation 21 , transoropharyngeal approach reduction combined with plate internal fixation 22 , only posterior approach to reduction, screw, and rod system fusion and internal fixation 23 , and other surgical schemes. In 2004, Goel 24 first reported that the treatment of BI with irreducible atlantoaxial dislocations by atlantoaxial joint distraction reduction and fixation through posterior approach.…”

Section: Discussionmentioning

confidence: 99%

The Classification of Axial Deformity in Patients with Basilar Invagination

Cao

Tian

et al. 2022

Orthopaedic Surgery

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Objective: To summarize the variation types of the axis in patients with basilar invagination (BI), then propose a classification scheme of the axis deformity.Methods: From December 2013 to September 2020, 92 patients (male 42, female 50) who were diagnosed with BI were studied retrospectively. Based on the imaging data of CT, the width and height of the axis pedicle and the sagittal diameter of the lateral mass were measured in each patient. According to the development of axis pedicle and lateral mass, the types of axis variation were summarized, and then the classification scheme of axis deformity was put forward.Results: All cases were analyzed and axis deformities were divided into four types. Type I: the axis is basically normal (53 cases, 57.6%). Type II: axis lateral mass is dysplasia (eight cases, 8.7%), which includes two subtypes: type IIA, the axis unilateral lateral mass is dysplasia (three cases); type IIB, the axis bilateral lateral masses are all dysplasia (five cases). Type III: axis pedicle is dysplasia (11 cases, 12%), which is subdivided into two subtypes: type IIIA, the axis unilateral pedicle is dysplasia (six cases); type IIIB, the axis bilateral pedicles are all dysplasia (five cases). Type IV: axis pedicle and lateral mass are all dysplasia (20 cases, 21.7%), this type contains the following four subtypes: type IVA, the unilateral axis pedicle and unilateral lateral mass (contralateral or ipsilateral) are all hypoplasia (four cases); type IVB, the unilateral axis pedicle and bilateral lateral masses are all hypoplasia (five cases); type IVC, the bilateral axis pedicles and unilateral lateral mass are all dysplasia (seven cases); type IVD, the bilateral axis pedicles and bilateral lateral masses are all dysplasia (four cases). The left and right abnormal lateral mass sagittal diameter (Type II) was (7.23 AE 1.39) mm and (5.96 AE 1.37) mm, respectively, the left and right abnormal pedicle width (Type III) was (2.61 AE 1.01) mm and (3.23 AE 0.66) mm, respectively, left and right abnormal pedicle height (Type III) was (5.43 AE 2.19) mm and (4.92 AE 1.76) mm, respectively. Moreover, the classification scheme has good repeatability and credibility. Conclusions:The classification about axis deformity could provide personalized guidance for axis screw placement in the BI and other upper cervical surgery, and axis screw placement errors would be effectively avoided.

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“…Some scholars attempted lateral mass bone grafting or cage implantation to assist the fusion of the atlantoaxial joint [19, 29]. This type of bone grafting is similar to the interbody fusion techniques used in the lumbar spine, and has a high fusion rate.…”

Section: Discussionmentioning

confidence: 99%

Comparison of imaging parameters pre- and post- reductive procedure for atlantoaxial dislocation via posterior fixation using pedicle screw and rod: a cross-sectional study

Shao

Gao

et al. 2019

BMC Musculoskelet Disord

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Background To compare the imaging parameters pre- and post- reductive procedure for atlantoaxial dislocation via posterior fixation using pedicle screw and rod. Methods Thirty-seven patients suffering from atlantoaxial dislocation underwent posterior reduction and internal fixation by pedicle screw and rod. We measured pre-operative and post-operative atlantodental interval (ADI), clivus-canal angle (CCA), cervicomedullary angle (CMA), sum of lateral mass interspace (SLMI) of the operation and the control group. ADI, CCA, CMA, and SLMI between the pre-operative and post-operative conditions of the operation group and the control group were compared. Results The ADI, CCA, CMA, and SLMI in the pre-operative condition of the operation group were 8.3 ± 4.3 mm, 130.2 ± 14.2°, 133.8 ± 16.7°, and 3.7 ± 1.3 mm, respectively, those in the post-operative condition of the operation group were 1.0 ± 0.9 mm, 148.5 ± 9.4°, 156.0 ± 8.2°, and 8.0 ± 2.7 mm, respectively, while those in the control group were 1.2 ± 0.3 mm, 152.7 ± 5.3°, 160.2 ± 6.3°, and 4.5 ± 1.0 mm respectively. Post-operative ADI, CCA, CMA, and SLMI were statistically different (p < 0.01) from pre-operative assessments. The SLMI has no significant difference between the pre-operative condition and the control group. Post-operative SLMI was statistically different from that of the control group. Conclusions The lateral mass joints were widened after the anatomical reduction of atlantoaxial dislocation by pedicle screw and rod. Widening of the lateral mass exists in both atlantoaxial fusion and occipital-cervical fusion.

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Bone Grafting of Atlantoaxial Joints and Occipitocervical or Atlantoaxial Fusion for the Reduction and Fixation of Basilar Invagination with Atlantoaxial Dislocation by a Posterior Approach: A Preliminary Study

Cited by 7 publications

References 26 publications

Early Outcomes of Bone Autografting in the Bilateral Atlantoaxial Joints Applied in Posterior Fusion Surgery

Early Outcomes of Bone Autografting in the Bilateral Atlantoaxial Joints Applied in Posterior Fusion Surgery

The Classification of Axial Deformity in Patients with Basilar Invagination

Comparison of imaging parameters pre- and post- reductive procedure for atlantoaxial dislocation via posterior fixation using pedicle screw and rod: a cross-sectional study

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