Goel's technique for the treatment of atlantoaxial dislocation with basilar invagination

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Objective To explore the surgical feasibility and clinical outcome of translateral mass and pars screws fixation (Goel's technique) in the treatment of atlantoaxial instability and dislocation. Methods Seventy ⁃ six patients were diagnosed as atlantoaxial dislocation, including 50 cases combined with occipitalization, and 26 patients with os odontoideum. Fifty ⁃ seven patients presented signs and symptoms of myelopathy or spinal cord injury. All of the patients underwent posterior operation of open reduction and arthrodesis with C1, 2 joint fixation with rods and screws in the lateral masses and pars articulars of the atlas and axis. Results Seventy⁃four cases obtained good outcome. The main Japanese Orthopaedic Association (JOA) scale increased from 9.43 ± 3.16 preoperation to 13.80 ± 2.07 postoperation (t = 4.063, P = 0.037). According to Odom's scoring system, 19 patients were assessed as excellent, 49 good, 7 fair and 1 poor. A complete reduction was achieved in 15 cases, 35 patients obtained partial reduction. Twenty ⁃ six patients underwent transoral anterior decompression. One patient occurred respiratory and cardiac arrest at 12 h after operation. One patient subjected disturbances of blood coagulation tetraplegia and recovered muscle power gradually recovered to grade 3. Fifty patients were followed up more than 3 months, all of them achieved articular fixation. JOA scale improved from 8.90 ± 1.22 before operation to 14.72 ± 1.57 (t = 4.914, P = 0.015) at the follow up period. In Odom's rank: assessment 18 patients were excellent, 30 good, 2 fair and 0 poor. Conclusion Posterior reduction and arthrodesis with rigid internal fixators by Goel's technique could achieve satisfactory outcomes in patients with atlantoaxial dislocation. DOI：10.3969/j.issn.1672⁃6731.2012.04.008