A novel technology for the treatment of irreducible atlantoaxial dislocation by transoral anterior approach: Mini Compressive Cervical Frame with Lateral Mass Cage

Abstract

Objective To investigate the clinical effect of transoral anterior anastomosis with C-JAWS and lateral joint cage for the treatment of irreducible atlantoaxial dislocation. Method From June 2012 to June 2015, 20 patients with irreducible atlantoaxial dislocation admitted to our hospital were included. Cervical X-ray, CT and MRI scans were utilized for the assessment of atlantoaxial dislocation and spinal cord compression before and after operations. The ADI was measured before and after the surgery, and the neurological status was assessed using JOA score. Regular follow-ups are conducted based upon X-ray, CT evaluation of reduction, internal fixation and fusion. Results Twenty patients underwent surgery successfully without neurovascular injuries. One patient complained of neck discomfort and another complained of throat foreign body sensation, while both were relieved after symptomatic treatments. ADI improved from 8.88 ± 2.13 mm to 1.53 ± 1.55 mm and the difference was statistically significant (t= 14.471, P = 0.000) before and after surgery. The JOA score improved from 10.60 ± 1.23 preoperatively to 14.65 ± 1.95 postoperatively and the difference was statistically significant (t= -16.480, P = 0.000) before and after surgery. Follow-up period is from 3 to 24 months with an average of 12 months. Cervical X-ray and CT showed no recurrence of dislocation. Cage locations were satisfied, and C-JAWS were fixed well. Bony fusion was gained from 3 to 6 months after the operation. Conclusions Transoral anterior C-JAWS plus lateral joint Cage surgery is an effective and alternatively operative method for the treatment of irreducible atlantoaxial dislocation.