Revision surgery of irreducible atlantoaxial dislocation: a retrospective study of 16 cases

Abstract

There is lack data concerning anterior cervical spine revision surgeries; even more data are missing concerning posterior cervical revision surgeries, to determine the feasibility, safety, and clinical efficacy of revision surgery for irreducible atlantoaxial dislocation (RS-IAAD). Patients with IAAD-FS underwent one-stage transoral release and posterior reduction. Their medical history was documented in detail. The JOA score system was used to evaluate each patient's neurological status pre and postoperatively, and serial MRI and radiographs were used to determine the status of the reduction and the autografts. 16 patients (average age, 36 years old) underwent successful surgery. There was no intraoperative or postoperative neurological deficit except in two cases that suffered transient neurological deficit that alleviated after conservative treatment. Solid bony union was seen at the end of 3 months after surgery in all patients. The mean follow-up period was 28.8 months (range 18-66 months). No pseudarthrosis was noted. Anterior transoral release and posterior instrumented fusion remain significant surgeries with the potential for serious complications, but in the current series there were no major complications.

Impact of Starting Point and Bicortical Purchase of C1 Lateral Mass Screws on Atlantoaxial Fusion

“…27,40 The remaining 32 studies were retrospective case series. 2,[4][5][6]8,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][28][29][30][31][32][33][34][35][36][37][38][39] All studies in this review provide class III evidence. The raw data from each study are summarized in the Table 1.…”

Sagittal Atlantoaxial Joint Inclination and Reduction Index Values for Diagnosis and Treatment of Irreducible Atlantoaxial Dislocation

“…However, the AAD is deeply located near the skull base, close to the medulla oblongata and the nerves, blood vessels, and glands in the anterior neck and is covered by the mandible; therefore, access and surgery are very difficult, with significant surgical risk. 20 21 The diagnostic criteria of IAAD vary, 4 5 22 and imaging standards that could guide the selection of surgical methods are lacking; specifically, no imaging standard has been devised to guide selection of a simple posterior approach or a combination with an anterior approach.…”

“… 1 2 3 The diagnostic criteria for IAAD are variable. According to Tan et al ., 4 if bone fusion and facet joint destruction can be ruled out by computed tomography (CT) reconstruction, a patient who cannot obtain satisfactory reduction, has an atlas-dens interval (ADI) ≥5 mm, or has adequate space available for the cord ≤13 mm after continuous skull traction with 5 kg for 1–2 weeks can be considered to have IAAD. Salunke et al .…”

Atlanto Axial Rotatory Dislocation in Adults: A Rare Complication of an Epileptic Seizure—Case Report

“…Many surgical approaches are described for the treatment of AARDs. 10 – 13) The posterior approach with the Harms fixation 14) is the gold standard in fixed luxations (AARF) achieving a complete realignment and a correct stabilization. It is useful to allow an intraoperative reduction distracting directly on the screw heads.…”