The Value and Limitation of Cervical Traction in the Evaluation of the Reducibility of Atlantoaxial Dislocation and Basilar Invagination Using the Intraoperative O-Arm

Duan, Wanru; Du, Yue-Qi; Qi, Tengfei; Jiang, Bowen; Wang, Kai; Liu, Zhenlei; Guan, Jian; Wang, Xingwen; Wu, Hao; Chen, Zan; Jian, Fengzeng

doi:10.1016/j.wneu.2019.08.160

Cited by 5 publications

(4 citation statements)

References 30 publications

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“…These imaging parameters make it easier, more accurate, and more specific in the diagnosis of BI. The majority of patients with BI need surgical treatment, and with the improvement of reduction technique and internal fixation, the posterior occipital cervical fusion surgery is an effective method for the treatment of BI and other various craniocervical junction diseases 7 , 8 . In 1994, Goel first reported the posterior atlantoaxial screw‐rod (plate) fixation technique, many scholars improved this technique, using it widely in posterior occipital cervical fusion surgery.…”

Section: Introductionmentioning

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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Section: Introductionmentioning

confidence: 99%

The Classification of Axial Deformity in Patients with Basilar Invagination

Cao

Tian

et al. 2022

Orthopaedic Surgery

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“…Direct anterior decompression of the spinal cord might be performed if traction reduction is not appropriate. At present, the most commonly accepted treatment protocol used to manage IAAD is transoral decompression and soft tissue release combined with posterior fixation 3 . The strategy requires a combined anterior and posterior approach, which increases the risk of surgical‐related injury and perioperative complications.…”

Section: Introductionmentioning

confidence: 99%

Usefulness of a Three‐Dimensional‐Printed Model in the Treatment of Irreducible Atlantoaxial Dislocation with Transoral Atlantoaxial Reduction Plate

et al. 2021

Orthopaedic Surgery

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Objective To evaluate the usefulness of a 3D‐printed model for transoral atlantoaxial reduction plate (TARP) surgery in the treatment of irreducible atlantoaxial dislocation (IAAD). Methods A retrospective review was conducted of 23 patients (13 men, 10 women; mean age 58.17 ± 5.27 years) with IAAD who underwent TARP from January 2015 to July 2017. Patients were divided into a 3D group (12 patients) and a non‐3D group (11 patients). A preoperative simulation process was undertaken for the patients in the 3D group, with preselection of the TARP system using a 3D‐printed 1:1 scale model, while only imaging data was used for the non‐3D group. Complications, clinical outcomes (Japanese Orthopaedic Association [JOA] and visual analogue score [VAS]), and image measurements (atlas–dens interval [ADI], cervicomedullary angle [CMA], and clivus‐canal angle [CCA]) were noted preoperatively and at the last follow up. Results A total of 23 patients with a follow‐up time of 16.26 ± 4.27 months were included in the present study. The surgery duration, intraoperative blood loss, and fluoroscopy times in the 3D group were found to be shorter than those in non‐3D group, with statistical significance. The surgery duration was 3.29 ± 0.45 h in the 3D group and 4.68 ± 0.90 h in the non‐3D group, and the estimated intraoperative blood loss was 131.67 ± 43.03 mL in the 3D group and 185.45 ± 42.28 mL in the non‐3D group. No patients received blood transfusions. The intraoperative fluoroscopy times were 5.67 ± 0.89 in the 3D group and 7.91 ± 1.45 in the non‐3D group. Preoperatively and at last follow up, JOA and VAS scores and ADI, CCA, and CMA were improved significantly within the two groups. However, no statistical difference was observed between the two groups. However, surgical site infection occurred in 1 patient in the 3D group, who underwent an emergency revision operation of the removal of TARP device and posterior occipitocervical fixation; the patient recovered 2 weeks after the surgery. In 2 patients in the traditional group, a mistake occurred in the placement of screws, with no neurological symptoms related to the misplacement. Conclusion Preoperative surgical simulation using a 3D‐printed real‐size model is an intuitive and effective aid for TARP surgery for treating IAAD. The 3D‐printed biomodel precisely replicated patient‐specific anatomy for use in complicated craniovertebral junction surgery. The information was more useful than that available with 3D reconstructed images.

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“…1 The condition can present with reducible or irreducible atlantoaxial dislocation (IAAD) patterns according to the skull traction test administered under general anesthesia. [2][3][4] Surgery is the main treatment for IAAD. However, the risk of perioperative complications is extremely high due to the complex anatomic structure and proximity to the spinal cord and vertebral arteries.…”

mentioning

confidence: 99%

“…Atlantoaxial dislocation is related to the loss of stability of lateral atlantoaxial and atlantodental joints and can result in severe neurological and spinal cord injury 1 . The condition can present with reducible or irreducible atlantoaxial dislocation (IAAD) patterns according to the skull traction test administered under general anesthesia 2–4 . Surgery is the main treatment for IAAD.…”

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confidence: 99%

A Novel Stepwise Technique for Safe and Effective Transoral Release of Irreducible Atlantoaxial Dislocation

et al. 2023

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Study Design. Retrospective cohort study. Objective. To verify the clinical efficacy of a novel transoral stepwise release technique (TSRT) for the treatment of irreducible atlantoaxial dislocations (IAAD). Summary of Background Data. Anterior release for IAAD remains challenging, with a 3.2 times higher complication rate than posterior release. However, there are some patients who cannot achieve successful reduction from a posterior approach and require the higher-risk anterior release. Our work presents a novel anterior release technique that aims to minimize iatrogenic injury and associated complications from an anterior release. Materials and Methods. IAAD cases who were treated with TSRT were retrospectively studied. Primary outcomes included fusion rate, complications, and neurological function over the course of a minimum 1-year follow-up. Radiographic differences between preoperative and postoperative imaging were also considered. A preoperative prediction model for the actual release grade was developed using multivariate logistic regression based on demographic factors and the craniovertebral abnormalities identified on preoperative images, evaluating the need for higher-grade TSRT release. Results. We included 201 IAAD cases, with 42% (84/201) demonstrating degeneration of the atlantoaxial joint or anterior–hook-like dens. The reduction was achieved in all cases, with 80% (160/201) of cases only requiring relatively low-grade or grade I types TSRT release. Degeneration of the atlantoaxial joint was significantly associated with the need for higher-grade TSRT release (odds ratio:16.68, CI: 2.91–94.54, P = 0.002). The overall complication rate was 4.5% (9/201). Over the course of follow-up, the fusion rate reached 98.5%, and the American Spinal Injury Association and Japanese Orthopedic Association scores were significantly improved to 97.28 and 16.25 (P < 0.01 and P < 0.01), respectively. Conclusion. This study demonstrated that our novel TSRT anterior release technique demonstrated complication rates similar to those published in the literature for posterior release. TSRT can be used as an alternative to posterior release techniques for refractory cases or when a posterior approach is not considered viable.

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The Value and Limitation of Cervical Traction in the Evaluation of the Reducibility of Atlantoaxial Dislocation and Basilar Invagination Using the Intraoperative O-Arm

Cited by 5 publications

References 30 publications

The Classification of Axial Deformity in Patients with Basilar Invagination

The Classification of Axial Deformity in Patients with Basilar Invagination

Usefulness of a Three‐Dimensional‐Printed Model in the Treatment of Irreducible Atlantoaxial Dislocation with Transoral Atlantoaxial Reduction Plate

A Novel Stepwise Technique for Safe and Effective Transoral Release of Irreducible Atlantoaxial Dislocation

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