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[An analysis of surgical outcome and influencing factors in patients of congenital basilar invagination with atlantal-axial dislocation: report of 120 cases].
Zhonghua Wai Ke Za Zhi. 2013 Mar; 51(3):207-10.ZW

Abstract

OBJECTIVE

To investigate the surgical outcome and its influencing factors in patients of congenital basilar invagination (BI) with atlanto-axial dislocation (AAD).

METHODS

From May 2004 to August 2010, 120 patients who had BI with AAD were surgically treated with direct posterior intraoperative distraction-reduction and fixation technique, 93 patients were successfully followed up by means of questionnaire survey, telephone and clinical evaluation. Pre- and postoperative dynamic cervical X-rays, computed tomographic scans, 3-dimentional reconstruction views and magnetic resonance imaging were performed. Pre- and postoperative Japanese Orthopaedic Association (JOA) score, distance between odontoid tip and Chamberlain's line and atlantodental interval were measured to evaluate the surgical result. Statistical analysis was performed by means of paired t test and Pearson Correlation analysis.

RESULTS

There were 93 cases were followed up for 24-99 months with an average of 46.5 months. Until the final follow-up, clinical symptoms were improved in 79 patients (84.9%), and were stable in 7 patients (7.5%) and deteriorated in 4 patients (4.3%). Three patients died postoperatively (3.2%). Patients without intramedullary signal intensity change (ISIC) had better surgical outcome. Patients with compression from anterior odontoid tip and posterior bone margin of occipital foramen had the worst surgical outcome (F = 3.987, P < 0.01). Overall, good decompression and bone fusion were shown on postoperative image in 87 patients (93.5%). There were 3 deaths in this series because of basilar artery thrombosis, posterior fossa hematoma and unknown reasons each.

CONCLUSIONS

The direct posterior intraoperative distraction-reduction and fixation technique is an effective simple and safe method for the treatment of BI with AAD. Anterior compression from odontoid tip and posterior compression from bone margin of occipital foramen-atlantal posterior arch play important roles in its developing mechanism. ISIC on MRI is a predictive factor for the worse surgical outcome.

Authors+Show Affiliations

Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

chi

PubMed ID

23859319

Citation

Wang, Xing-wen, et al. "[An Analysis of Surgical Outcome and Influencing Factors in Patients of Congenital Basilar Invagination With Atlantal-axial Dislocation: Report of 120 Cases]." Zhonghua Wai Ke Za Zhi [Chinese Journal of Surgery], vol. 51, no. 3, 2013, pp. 207-10.
Wang XW, Jian FZ, Chen Z, et al. [An analysis of surgical outcome and influencing factors in patients of congenital basilar invagination with atlantal-axial dislocation: report of 120 cases]. Zhonghua Wai Ke Za Zhi. 2013;51(3):207-10.
Wang, X. W., Jian, F. Z., Chen, Z., Wu, H., & Bao, Y. H. (2013). [An analysis of surgical outcome and influencing factors in patients of congenital basilar invagination with atlantal-axial dislocation: report of 120 cases]. Zhonghua Wai Ke Za Zhi [Chinese Journal of Surgery], 51(3), 207-10.
Wang XW, et al. [An Analysis of Surgical Outcome and Influencing Factors in Patients of Congenital Basilar Invagination With Atlantal-axial Dislocation: Report of 120 Cases]. Zhonghua Wai Ke Za Zhi. 2013;51(3):207-10. PubMed PMID: 23859319.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [An analysis of surgical outcome and influencing factors in patients of congenital basilar invagination with atlantal-axial dislocation: report of 120 cases]. AU - Wang,Xing-wen, AU - Jian,Feng-zeng, AU - Chen,Zan, AU - Wu,Hao, AU - Bao,Yu-hai, PY - 2013/7/18/entrez PY - 2013/7/19/pubmed PY - 2014/3/22/medline SP - 207 EP - 10 JF - Zhonghua wai ke za zhi [Chinese journal of surgery] JO - Zhonghua Wai Ke Za Zhi VL - 51 IS - 3 N2 - OBJECTIVE: To investigate the surgical outcome and its influencing factors in patients of congenital basilar invagination (BI) with atlanto-axial dislocation (AAD). METHODS: From May 2004 to August 2010, 120 patients who had BI with AAD were surgically treated with direct posterior intraoperative distraction-reduction and fixation technique, 93 patients were successfully followed up by means of questionnaire survey, telephone and clinical evaluation. Pre- and postoperative dynamic cervical X-rays, computed tomographic scans, 3-dimentional reconstruction views and magnetic resonance imaging were performed. Pre- and postoperative Japanese Orthopaedic Association (JOA) score, distance between odontoid tip and Chamberlain's line and atlantodental interval were measured to evaluate the surgical result. Statistical analysis was performed by means of paired t test and Pearson Correlation analysis. RESULTS: There were 93 cases were followed up for 24-99 months with an average of 46.5 months. Until the final follow-up, clinical symptoms were improved in 79 patients (84.9%), and were stable in 7 patients (7.5%) and deteriorated in 4 patients (4.3%). Three patients died postoperatively (3.2%). Patients without intramedullary signal intensity change (ISIC) had better surgical outcome. Patients with compression from anterior odontoid tip and posterior bone margin of occipital foramen had the worst surgical outcome (F = 3.987, P < 0.01). Overall, good decompression and bone fusion were shown on postoperative image in 87 patients (93.5%). There were 3 deaths in this series because of basilar artery thrombosis, posterior fossa hematoma and unknown reasons each. CONCLUSIONS: The direct posterior intraoperative distraction-reduction and fixation technique is an effective simple and safe method for the treatment of BI with AAD. Anterior compression from odontoid tip and posterior compression from bone margin of occipital foramen-atlantal posterior arch play important roles in its developing mechanism. ISIC on MRI is a predictive factor for the worse surgical outcome. SN - 0529-5815 UR - https://www.unboundmedicine.com/medline/citation/23859319/[An_analysis_of_surgical_outcome_and_influencing_factors_in_patients_of_congenital_basilar_invagination_with_atlantal_axial_dislocation:_report_of_120_cases]_ L2 - http://journal.yiigle.com/LinkIn.do?linkin_type=pubmed&amp;issn=0529-5815&amp;year=2013&amp;vol=51&amp;issue=3&amp;fpage=207 DB - PRIME DP - Unbound Medicine ER -