The surgical treatment of the chronic atlantoaxial rotatory dislocation with C1, 2 lateral facet locked through combined anterior and posterior approach

Abstract

Objective To describe the clinical manifestation of the chronic atlantoaxial rotatory dislocation (AARD) with C1, 2 lateral facets locked, and explore the effect of the operation combined with anterior retropharyngeal approach and posterior approach. Methods Data of 8 patients with chronic AARD with C1, 2 lateral facet locked who had undergone open reduction with the anterior retropharyngeal approach and C1, 2 transpedicular screw fixation with autologous iliac bone graft from Oct. 2010 to Jun. 2013 were retrospectively analyzed. There were 4 males and 4 females with an average age of 31 years old (range, 11-57 years old). The intervals from onset to diagnosis were from 29 to 180 days and the mean time was 70.6 days. 5 cases were chronic AARD with right C1, 2 lateral facets locked and 3 with left C1, 2 lateral facets locked. Reduction was failed to obtain by traction for two to four weeks. Subsequently, after open reduction with the anterior retropharyngeal approach, the patients were performed C1, 2 transpedicular screw fixation with autologous iliac bone graft for one stage or two. Results 1 patient underwent open reduction with the anterior retropharyngeal approach in stage one and C1, 2 transpedicular screw fixation in stage two because of an overall severe condition, and the other patients did anterior and posterior operation in one stage. The average operation time was 205 min (range, 160-260 min). The mean blood loss was 210 ml (range, 100-300 ml). There were no operation complications except one young girl reflected pain in autologous iliac donated area, and pain relieved when taking nonsteroidal antiinflammatory by oral for one week. All patients had been followed up for a mean period of 14.8 months (range, 5-37 months). Three-dimensional computed tomography revealed C1, 2 arthrodesis bone graft fusion from two to four months and the average was 3.1 months. Neither recurrence of symptoms nor dislocation was observed at the latest follow-up. Conclusion Open reduction through the anterior retropharyngeal approach with C1, 2 transpedicular screw fixation is an effective treatment strategy for chronical AARD with C1, 2 lateralfacets locked, which reduces surgical complications with less operation difficulty. Key words: Cervical atlas; Axis; Atlanto-axial joint; Dislocations