Transoral atlantoaxial reduction plate internal fixation for the treatment of irreducible atlantoaxial dislocation: a 2- to 4-year follow-up

Abstract

To evaluate the mid-term outcomes of transoral atlantoaxial reduction plate (TARP) internal fixation for the treatment of irreducible atlantoaxial dislocation. From April 2003 to April 2005, 31 patients with irreducible atlantoaxial dislocation were treated with TARP internal fixation. The average age was 37.9 years (range, 15-69 years). The subjective symptoms, objective signs, and neurological function of the patients were assessed. Radiography and magnetic resonance imaging (MRI) were performed and the results analyzed according to the Symon and Lavender clinical standard, Japanese Orthopaedic Association (JOA) score for spinal cord function and imaging standard for spinal cord decompression. Complete or almost complete anatomical reduction was obtained in all 31 patients. No screw-loosening or atlantoaxial redislocation was found in 29 cases. According to the Symon and Lavender clinical standard, 14 cases had recovered completely, 7 to mild, 6 to moderate, and 4 to severe type by final follow-up, compared to the preoperative classifications of 4 as moderate, 15 as severe, and 12 as extra severe type. The outcome for 26 patients was evaluated as excellent and in 5 as adequate. The average postoperative improvement in spinal cord function was 73.3% and of decompression of the cervical cord 92.6%. The only complication was loosening of screws in two cases with senile osteoporosis. One case underwent TARP revision surgery and the other posterior occipitocervical internal fixation. Both of them were eventually cured. The TARP operation is a good choice for patients with irreducible atlantoaxial dislocation and has valuable clinical application.