Surgical management of irreducible atlantoaxial dislocation.

Abstract

Objective To investigate the atlantoaxial release method and evaluate the effects of posterior pedicle screw rod system in the treatment of irreducible atlantoaxial dislocation. Methods Nine-teen patients with irreducible ariantoaxial dislocation were retrospectively analyzed, including 15 males, and 4 females, with the average age of 41.5 years (ranged 11 to 66 years). There were 15 patients with atlas an-terior dislocation, 4 with atlas posterior dislocation. All of patients complained of neck pain, neck activities restricted, and 14 of cases with symptoms of cervical spinal cord compression. All of patients received X-ray,MRI and CT three-dimensional reconstruction to measure translocation and rotation of atlas. According to the types and extent of irreducible atlantoaxial dislocation, anterior or/and posterior atlantoaxial release had been chosen. With continuous skull traction, the atlas was redueted and fixed with pediele screws. Fusion of at-lantoaxial had performed by lilac bone graft. Brace of head, neck and thoracic were kept for protection 12 weeks after surgeries. Results All patients were followed up 10-60 months, average 26.4 months. Com-plains of neck pain and numbness of limbs disappeared after surgery. The bone graft fused with atlantoaxial at 4.5 months in average. Translocation of atlas decreased from (8.7±2.6) mm preoperatively to (2.6±1.2) mm postoperatively. Rotation of arias deereased from (17.3°±5.8°) preoperatively to (5.0°±2.4°) postoperatively (P<0.05). No nerve or vertebral artery injuries, internal fixation failures or infections were observed. Conclu-sion The atlantoaxial release method should be chosen, according to the types and extend of atlantoaxial dislocation. A suitable release and reduction of atlantoaxial, combining with posterior pedicle screw fixation and the iliac bone fusion is an effective treatment for irreducible ariantoaxial dislocation. Key words: Atlas; Axis; Dislocation; Internal fixators