Dislocation Of Atlantoaxial Joint Research Articles

Using additive manufacturing for craniocervical reconstruction in traditionally challenging cases.

Retrospective case series. The aim of this study was to evaluate the clinical outcomes and effectiveness of using 3D printed implants in upper cervical spine and occipitocervical junction surgery. C2 primary tumor patients who required axial en bloc resection and other patients who required partial bone decompression using customized 3D printed implants or fixation devices for surgery were included. Evaluate the stability and surgical outcomes of 3D printed implants through perioperative and follow-up period. Five tumor patients underwent reconstruction using customized 3D printed artificial vertebral bodies, while another five patients with atlantoaxial joint dislocation underwent reduction and decompression using customized 3D printed internal fixation devices. The postoperative imaging results showed that the 3D printed structures had good immediate stability and had no signs of displacement or subsidence. Follow up showed that all five cases of vertebral body reconstruction had achieved fusion. Only one patient died one month after surgery due to infection and respiratory difficulties. Other patients showed excellent improvement in neurological function in follow up. The use of 3D printed implants in surgery involving the occipitocervical area is a feasible and reliable alternative choice. It is a valuable attempt for complex atlantoaxial dislocation that cannot be treated with conventional instruments. 3D printed implants can improve the safety and accuracy of surgery, provide good immediate stability, have a low incidence of subsidence, fewer related complications during the follow-up period.

Effects of traction therapy on atlantoaxial joint dislocation-induced cervical vertigo.

Cervical vertigo is a common complication of atlantoaxial joint dislocation. However, there is no consensus on the effects of different therapies on the recovery of the patients suffering cervical vertigo. The objective of this randomized controlled trial was to investigate the effect of traction therapy on reducing cervical vertigo induced by atlantoaxial joint dislocation. A total of 96 patients were randomized to receive traction therapy or traditional therapy for two weeks. The overall clinical efficacy was measured based on the 30-point cervical vertigo symptom and function evaluation form. The therapeutic effects were also evaluated based on lateral atlantodental space (LADS), vertigo scale, neck and shoulder pain scale, headache scale, daily life and work scale, psychosocial adaptation scale, and quality of life. Compared with the traditional therapy group, the traction group demonstrated markedly higher overall clinical efficacy (P=0.038). Both the traction therapy group and the traditional therapy group showed significant decrease in LADS (P<0.001), but the traction therapy group had a greater reduction of LAD compared with the traditional group (P<0.01). Traction therapy consistently led to significantly greater relief of cervical vertigo symptoms, including dizziness, neck and shoulder pain, headache, inconvenience in daily living and work activities, impaired psychosocial adaptation, while improving quality of life. The efficacy of traction therapy for cervical vertigo surpasses that of traditional therapy, suggesting that traction therapy is potentially more clinically useful in treating these patients.

Treatment strategy and curative effect analysis of os odontoideum complicated with atlantoaxial joint dislocation

To explore the treatment strategy and clinical efficacy for os odontoideum complicated with atlantoaxial dislocation. The clinical data of 17 patients with os odontoideum complicated with atlantoaxial dislocation surgically treated from January 2006 to January 2015 were retrospectively analyzed, including 7 males and 10 females, aged 17 to 53 (43.1±11.3) years old;course of disease was 3 to 27(10.2±6.9) months. All patients received cranial traction before operation, 12 of 14 patients with reducible dislocation were treated by posterior atlantoaxial fixation and fusion, and 2 patients with atlantooccipital deformity were treated by posterior occipitocervical fixation and fusion;3 patients with irreducible alantoaxial dislocation were treated by transoral approach decompression combined with posterior atlantoaxial fixation and fusion. The operation time, intraoperative blood loss and perioperative complications were recorded. Visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score were used to evaluate the change of neck pain and neurological function. Atlantoaxial joint fusion rate was evaluated by CT scan. The operation time of posterior fixation and fusion ranged from 86 to 170 (92.2±27.5) min, and the intraoperative blood loss was 200-350 (250.7±65.2) ml. No vertebral artery injury and spinal cord injury were recorded. Among the patients underwent atlantoaxial fixation and fusion, 1 patient with reducible dislocation fixed by C2 laminar screw lost reduction after primary operation, and received anterior release again and finally occipitocervical fusion. All patients were followed up for 15 to 58 (32.0±12.2) months. VAS score was decreased from preoperative 4.2±0.9 to 1.3±0.7 at final follow up and the JOA score was improved from preoperative 11.2±1.2 to 16.9±0.8 at final follow-up. CT scan confirmed that the atlantoaxial or occipitocervical fusion wasgood, and the fusion time was 5 to 9 (6.7±0.6) months. Surgical treatment of os odontoideum complicated with atlantoaxial dislocation can achieve satisfactory results, improve the patient's neurological function and improve the quality of life, however the surgical options needs to be individualized.

A Case Report of Complete Dislocation of Atlantoaxial Joint due to a Traumatic and Pathological Axial Lesion.

Atlantoaxial dislocation usually results in sudden death. The patient had never found any axial lesion before, and the atlantoaxial joint dislocation was caused by rotation of the neck due to discomfort of the neck. The patient was given surgical treatment after the rescue of respiratory and cardiac arrest during transportation, which was extremely rare and rarely reported. A 62-year-old male patient presented with limited cervical mobility after a violent rotation of the neck due to neck discomfort. X-ray and computed tomography (CT) scan suggested atlantoaxial dislocation. Sudden respiratory and cardiac arrest during transportation was immediately followed by continuous cranial traction and successful occipital and neck fusion operation. After the successful rescue of endotracheal intubation, the patient was given continuous cranial traction. After the completion of CT scan, the patient was given occipital neck fusion, and 6 days after the surgery, the patient wore the skull-neck-thorax brace and walked freely. Continuous cranial traction and posterior occipitocervical fusion are effective methods for treating axial pathological fracture with atlantoaxial dislocation. 5.

Anatomical study in exposed area and operating space of extended endonasal approach to the ventral region of cranio-cervical junction

Objective To explore the scope, feasibility and indications of extended neuroendoscopic endonasal approach to reveal the region of cranial-cervical junction. Methods Ten (20 sides) intact frozen adult cadaveric heads were used to simulate the extended neuroendoscopic endonasal approach to remove the anterior tubercle of atlas, part of the atlas anterior arch, odontoid and part of the slope. In the cranial-cervical junction area, we observed the exposed range and measured the distance from the nostril to the anterior tubercle of atlas, the height and width of the anterior arch of the atlas, the distance of bilateral medial margin of occipital condyle, the distance of bilateral medial margin of the foramen lacerum, the vertical distance from the occipital condyle to the homolateral foramen lacerum, and the height, anteroposterior diameter and transverse diameter of the odontoid. Results The exposed range of the extended neuroendoscopic endonasal approach was as follows: when the lesion was located at the foramen magnum, the medial margin of the occipital condyle was the boundary of both sides, the root of the odontoid was the lower boundary, and the lower edge of the occipital bone was the upper boundary. When the lesion was located at the region of cranial-cervical junction, the upper edge of the foramen lacerum on both sides was the upper boundary, and the foramen lacerum and the outer edge of the occipital condyle were the boundaries of both sides of the bone window. By measurement, the distance from the nostril to the anterior tubercle of atlas was 8.9-9.7 cm, with an average of 9.3±0.3 cm. The height of the anterior arch of the atlas was 2.3-3.0 cm, with an average of 2.7±0.3 cm; the width was 1.5-2.0 cm, with an average of 1.8±0.2 cm; the distance of bilateral medial margin of occipital condyle was 1.5-2.0 cm, with an average of 1.8±0.2 cm; the distance of bilateral medial margin of the foramen lacerum was 2.1-2.9 cm, with an average of 2.4 ±0.3 cm; the vertical distance from the occipital condyle to the homolateral foramen lacerum was 1.6-2.2 cm, with an average of 1.9±0.3 cm; the height of the odontoid was 0.9-1.3 cm, with an average of 1.1±0.2 cm, its length was 0.8-1.3 cm, with an average of 1.1±0.2 cm; the transverse diameter of the dentate was 0.9-1.2 cm, with an average of 1.0±0.1 cm.The maximum exposed area of cranio-cervical junction was 6.4-9.8 cm2, with an average of 8.6±1.6 cm2. Conclusion The extended neuroendoscopic endonasal approach with removal of the anterior tubercle of atlas and part of the atlas anterior arch could effectively reveal the cranial-cervical junction area which is suitable for the treatment of odontoid deformity, skull base depression and atlantoaxial joint dislocation as well as resection of epidural tumors in the cranial-cervical junction and ventral and ventral midline tumors. Key words: Natural orifice endoscopic surgery; Anatomy; Cranio-cervical junction; Extended endonasal approach

Improved lateral mass atlas screw-axial pedicle screw combined with posterior atlantoaxial tension band fixation for traumatic atlantoaxial instability

Objective To investigate the clinical effects of modified posterior lateral mass atlas screw-axial pedicle screw combined with posterior atlantoaxial tension band for treatment of atlantoaxial instability.Methods From October 2007 to October 2012,23 cases of atlantoaxial instability were immobilized with modified posterior lateral mass atlas screw-axial pedicle screw combined with posterior atlantoaxial tension band.There were 15 males and 8 females with mean age of (42.6 ± 2.7) years (range,32-61 years).Eleven cases were diagnosed as odontoid process fracture combined with atlantoaxial joint dislocation,5 as anterior dislocation of the atlas,and 7 as atlantoaxial joint rotary subluxation.All cases suffered from notable occipitocervical pain and activity restriction,but with no neurological deficit.After atlantoaxial fixation,concurrent posterior fusion was done with iliac autograft or cancellous bone allograft.Follow-up was made at postoperative 3,6,and 12 months,followed by once a year.Results Mean operation time was 120-150 min [(131.7 ± 25.4) min] and mean bleeding was 320-600 ml [(417.6 ± 53.4)ml].All cases went through operations without the occurrence of death or complications months of follow-up (range,12-36 months).All cases obtained bony fusion one year after operation.Conclusion Lateral mass atlas screw-axial pedicle screw combined with posterior atlantoaxial tension band can be feasible and safe in treatment of traumatic atlantoaxial instability.such as nerve blood vessel injury.No implant loosening or breakage occurred after mean (20.7 ± 3.1) Key words: Spinal fractures ; Atlanto-axial joint; Atlantoaxial instability

Atlanto-axial dislocation complicating a type II odontoid fracture. Reduction and final fixation

A case of traumatic posterolateral C1-C2 dislocation associated with odontoid fracture is reported. This is a rare case of traumatic posterolateral C1-C2 dislocation associated with odontoid fracture. Its management is discussed. A traumatic dislocation of atlanto-axial joint associated with an odontoid fracture remains a rare injury. No case of posterior dislocation has been reported so far in the literature with this type of management. The case is of a 25 year-old-man with a primary atlanto-axial posterolateral dislocation associated with a type II displaced odontoid fracture without any neurological complication. The patient underwent gentle traction during 24hours with a halo frame. An incomplete reduction was achieved. Two days later, a complete reduction was obtained thanks to a preoperative manual traction maintained by a Mayfield (R) modified skull clamp. Anterior C1-C2 fixation was performed according to Vaccaro's technique. The patient wore a cervical collar and underwent physiotherapy during three months. To our best knowledge, this case represents the first traumatic atlanto-axial dislocation associated with an odontoid fracture which was treated through retropaharyngeal approach. This had been rendered possible thanks to the final reduction maneuver in extension.

Application of separating fusing opacifying and false-coloring-volume rendering imaging technique in the region of atlantoaxial joint

Objective To evaluate the techniques of separating, fusing, opacifying and falsecoloring- volume rendering( SFOF-VR)3D imaging on the bone and blood vessels in the region of atlantoaxial joint(AAJ). Methods SFOF-VR 3D imaging was performed on 35 cases, including normal (n = 6),variations and lesions( n =29), which were selected from cases with the head-neck CTA examination. With the original scanning data, the VR imaging was performed, then SFOF-VR imaging. Comparisons were made between the features of 3D images of SFOF-VR and VR in showing the anatomy, diagnosing the variation and lesion of AAJ and VA, and the results were analyzed by using the Fisher exact test. Results The results of 35 cases included 6 normal cases in the region of atlantoaxial joint and VA, 16 variations in atlantoaxial joint or VA, 6 cases with arteriosclerosis in VA and 7 cases with fracture or dislocation of atlantoaxial joint. All SFOF-VR imaging are satisfactory. SFOF-VR imaging can show the atlas, epistropheus and VA independently or jointly, cut or color the structures freely and get 3D measurements in any direction.Comparisons showed that SFOF-VR images were much clearer and more comprehensive than VR in displaying the anatomy, variation and lesions of AAJ and VA. Statistical differences were found in showing the spatial structure, blocking structure, space measurement, variation and disease and image edge ( there are25,7,3,0, 31,3,1,0, 26,3,6,0, 23,7,5,0, 0,10,20,5 cases for SFOF-VR image with excellent,good, ordinary and poor quality, and 2,5,24,4, 0,2,8,25, 0,7,25,3, 5,6,23,1, 29,4,2,0 cases for VR;χ2 values 40. 259, 61.444, 42.245, 24.220, 51.299, P<0. 01 ). Conclusions SFOF-VR is a new 3D imaging technique which can clearly and directly show the bones and blood vessels in the region of AAJ.It can provide anatomical information for imaging diagnosis and surgical operation. Key words: Atlanto-axial joint; Blood vessels; Imaging, three-dimensional; Tomography,X-ray computed

Unusual form of spinal tuberculosis: involvement of atlantoaxial joint

A 40-year-old woman who had neck pain and weakness in her extremities for 3 months was investigated. Anterior dislocation of atlantoaxial joint was detected on plain film. Epidural soft tissue mass leading spinal cord compression was found at the atlantoaxial joint on MR examination. The odontoid process was destructed as well. The soft tissue mass was isointense with spinal cord and non-homogenous hyperintense to vertebrae on T1-weighted images, and hyperintense on T2-weighted images. The mass was significantly enhancing on the post-gadolinium series. Transoral aspiration and culture of aspirated material confirmed that the soft tissue mass was a tuberculous abscess. Isolated atlantoaxial involvement of tuberculosis is exceedingly rare but carries a risk of compression of the upper spinal cord. Clinical picture and radiological findings were discussed.

非外傷性環軸椎側方脱臼の一例

A case of lateral dislocation of atlanto-axial joint is reported. This case was a 65 years old man who had had severe pain in posterior neck and occipital lesion. Radiographs showed lateral dislocation of atlanto-axial joint. This patient was xero positive and there were erosions in atlanto-axial joints, which suggested that the cause of lateral dislocation was RA. Complete relief was obtained immediately after posterior fusion by Mcgraw's method and he has been assymptomatic 7 weeks postoperatively.Anterior dislocation of atlanto-axial joint is very common. Posterior, upward and rotatory dislocation of atlanto-axial joint are sometimes seen. But lateral dislocation of atlantoaxial joint is very rare. We could not find the report of lateral dislocation of atlanto-axial joint caused by RA.

On the Old Cases of Atlanto-Axial Disorders with Wry Neck

Rotary fixation and locking rotary dislocation of atlanto-axial joint after inflammation or trauma are well known as a cause of the wry neck.Authors report each case of the rotary fixation and locking rotary dislocation treated recently and discuss some clinical problems.