Selection of indications and surgical treatment of basilar invagination with atlantoaxial dislocation

Abstract

To evaluate the indications and effect of surgical treatment of basilar invagination (BI) with atlantoaxial dislocation (AAD) on the basis of retrospective analysis of the clinical and imaging data of patients. Consecutive 21 patients with BI and AAD were surgically treated in Department of Spinal Surgery, The First Affiliated Hospital of Xinjiang Medical University from July 2000 to December 2013. There were 10 males and 11 females, aged from 7 to 59 years, with a mean of 36.4 years. The clinical symptoms and signs was recorded, and preoperative imaging examination including anteroposterior, lateral, dynamic films, MRI, CT and 3-dimensional reconstruction views of cervical spine were performed to identify the series. All cases were treated with operation. Neurological function was assessed by JOA scale and NDI score before, after surgery and at final follow-up. The postoperative X-rays, MRI or CT was taken to observed the results of decompression, fixation and fusion. There were 5 cases operated by posterior approach, combined anterior and posterior approach in 16 cases, atlantoaxial fixation in 2 cases, occipitocervical fixation in 19 cases. The average operation time was 200 mins, blood loss was 230 ml. Except for 2 death cases, 19 cases were followed up, the followed-up was arranged from 13 to 42 months, with an average of 21.6 months. Compared with preoperative parameters (7.8±1.3), the postoperative scores of JOA decreased significantly (14.1±0.5) and at the final follow-up (16.2±0.7) (P<0.05); compared with preoperative parameters (65.7±11.2), the postoperative scores of NDI decreased significantly (28.2±9.6) and at the final follow-up (22.7±7.4) (P<0.05) and no significant difference in JOA or NDI score existed between post-operation and last follow-up (P>0.05). The perioperative complications was discovered in 6 cases, including infection in 2 cases, cerebrospinal fluid (CSF) leakage in 2 cases, respiratory dysfunction, cleft palate in 1 case, respectively. BI with AAD can be treated by anterior, posterior or combined approaches. Careful evaluation, proper selection of indications and prevention of perioperative complications are important consideration to ensure the success of surgery.