Treatment of dens fracture combined with recoverable atlantoaxial dislocation with posterior fusion plus pedicle screw

Abstract

Objective To report the clinical results of posterior fusion plus pediele screw fixation for treatment of dens fracture combined with recoverable atlantoaxial dislocation. Methods From April 2006 to September 2008,17 cases of dens fractures combined with recoverable atlantoaxial dislocation were treated with posterior pedicle screw fixation.reduction and fusion.Skull traction was made to restore the normal atlantoaxial joint before the operation.The spinal cord functions were evaluated by the system of Japanese Orthopaedics Association(JOA). Results Followups for 12 to 38 months(average,18 months)showed that the aflantoaxial alignment and stability were restored in all the patients,without complications due to instrumentation.The average JOA scores improved significantly from the preoperative 10.2±2.4 points to the 15.7±1.9 at the last followup(t=9.078,P<0.05).The follow-ups showed that the functional improvement rate of spinal cord ranged from 35%to 95%,averaging 68.5%. Conclusion Since posterior atlantoaxial pedicle screw and rod fixation provides immediate three-dimensional rigid fixation of the atlantoaxial joint,it may be a more effective technique than previously reported techniques. Key words: Dentategrus; Fractures; Atlantoaxial joint; Dislocation; Fracture fixation,intemal