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Treatment of basilar invagination with atlantoaxial dislocation: atlantoaxial joint distraction and fixation with transoral atlantoaxial reduction plate (TARP) without odontoidectomy.
Eur Spine J. 2014 Aug; 23(8):1648-55.ES

Abstract

PURPOSE

Although direct transoral decompression and one-stage posterior instrumentation can obtain satisfactory cord decompression for the treatment of basilar invagination with atlantoaxial dislocation, surgical injuries run high as combinative anterior-posterior approaches were necessary. Furthermore, the complications will rise notably when involvement of dens and/or clivus in the decompression necessitates relatively complicated surgical techniques. First initiated in 2005, transoral atlantoaxial reduction plate (TARP) works as an internal fixation for the treatment of basilar invagination with irreducible atlantoaxial dislocation. Therefore, this article aimed to describe several operative experiences about this approach, which has delivered successful decompression, fixation and fusion.

METHODS

21 consecutive patients with basilar invagination underwent the TARP operation. The pre- and postoperative medulla-cervical angles were measured and compared. The JOA scores of spinal cord function were calculated pre- and post-operatively. 20 cases (20/21) were followed up to average 12.5 months.

RESULTS

Symptoms of all the 20 cases were relieved in different degrees. The postoperative imaging showed the odontoid processes obtained ideal reduction and the internal fixators were all in good position. The medulla-cervical angle was correctd from an average (± standard deviation) 128.7° + 11.9° (n = 20) before surgery to 156.5° + 8.1° (n = 20) after surgery (P < 0.01). The average preoperative and postoperative Japaneses Orthopedic Association scores were 11.25 (n = 20) and 15.9 (n = 20), respectively, indicating 76 % improvement. Screw-loosening was observed in one patient due to severe osteoporosis. After a revised operation with a TARP in another size, the neurological symptoms showed no obvious improvements. Then the treatment was terminated.

CONCLUSIONS

The TARP operation and intra-operative traction could reduce the odontoid process superiorly migrating into the foramen magnum, directly ease the ventral compression of spinal cord, and fix the reduced atlantoaxial joints through a single transoral approach without the need of a posterior operation. In this stury, 21 patients were evaluated and 20 did well with TARP operation. The preliminary clinical result was satisfactory.

Authors+Show Affiliations

Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command (Liuhuaqiao Hospital), No.111 Liuhua Avenue, Guangzhou, People's Republic of China, hong_xia126@126.com.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo 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

eng

PubMed ID

24838509

Citation

Xia, Hong, et al. "Treatment of Basilar Invagination With Atlantoaxial Dislocation: Atlantoaxial Joint Distraction and Fixation With Transoral Atlantoaxial Reduction Plate (TARP) Without Odontoidectomy." European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, vol. 23, no. 8, 2014, pp. 1648-55.
Xia H, Yin Q, Ai F, et al. Treatment of basilar invagination with atlantoaxial dislocation: atlantoaxial joint distraction and fixation with transoral atlantoaxial reduction plate (TARP) without odontoidectomy. Eur Spine J. 2014;23(8):1648-55.
Xia, H., Yin, Q., Ai, F., Ma, X., Wang, J., Wu, Z., Zhang, K., Liu, J., & Xu, J. (2014). Treatment of basilar invagination with atlantoaxial dislocation: atlantoaxial joint distraction and fixation with transoral atlantoaxial reduction plate (TARP) without odontoidectomy. European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 23(8), 1648-55. https://doi.org/10.1007/s00586-014-3378-8
Xia H, et al. Treatment of Basilar Invagination With Atlantoaxial Dislocation: Atlantoaxial Joint Distraction and Fixation With Transoral Atlantoaxial Reduction Plate (TARP) Without Odontoidectomy. Eur Spine J. 2014;23(8):1648-55. PubMed PMID: 24838509.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of basilar invagination with atlantoaxial dislocation: atlantoaxial joint distraction and fixation with transoral atlantoaxial reduction plate (TARP) without odontoidectomy. AU - Xia,Hong, AU - Yin,QingShui, AU - Ai,FuZhi, AU - Ma,XiangYang, AU - Wang,JianHua, AU - Wu,ZengHui, AU - Zhang,Kai, AU - Liu,JingFa, AU - Xu,JunJie, Y1 - 2014/05/18/ PY - 2013/12/14/received PY - 2014/05/07/accepted PY - 2014/05/06/revised PY - 2014/5/20/entrez PY - 2014/5/20/pubmed PY - 2015/5/2/medline SP - 1648 EP - 55 JF - European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society JO - Eur Spine J VL - 23 IS - 8 N2 - PURPOSE: Although direct transoral decompression and one-stage posterior instrumentation can obtain satisfactory cord decompression for the treatment of basilar invagination with atlantoaxial dislocation, surgical injuries run high as combinative anterior-posterior approaches were necessary. Furthermore, the complications will rise notably when involvement of dens and/or clivus in the decompression necessitates relatively complicated surgical techniques. First initiated in 2005, transoral atlantoaxial reduction plate (TARP) works as an internal fixation for the treatment of basilar invagination with irreducible atlantoaxial dislocation. Therefore, this article aimed to describe several operative experiences about this approach, which has delivered successful decompression, fixation and fusion. METHODS: 21 consecutive patients with basilar invagination underwent the TARP operation. The pre- and postoperative medulla-cervical angles were measured and compared. The JOA scores of spinal cord function were calculated pre- and post-operatively. 20 cases (20/21) were followed up to average 12.5 months. RESULTS: Symptoms of all the 20 cases were relieved in different degrees. The postoperative imaging showed the odontoid processes obtained ideal reduction and the internal fixators were all in good position. The medulla-cervical angle was correctd from an average (± standard deviation) 128.7° + 11.9° (n = 20) before surgery to 156.5° + 8.1° (n = 20) after surgery (P < 0.01). The average preoperative and postoperative Japaneses Orthopedic Association scores were 11.25 (n = 20) and 15.9 (n = 20), respectively, indicating 76 % improvement. Screw-loosening was observed in one patient due to severe osteoporosis. After a revised operation with a TARP in another size, the neurological symptoms showed no obvious improvements. Then the treatment was terminated. CONCLUSIONS: The TARP operation and intra-operative traction could reduce the odontoid process superiorly migrating into the foramen magnum, directly ease the ventral compression of spinal cord, and fix the reduced atlantoaxial joints through a single transoral approach without the need of a posterior operation. In this stury, 21 patients were evaluated and 20 did well with TARP operation. The preliminary clinical result was satisfactory. SN - 1432-0932 UR - https://www.unboundmedicine.com/medline/citation/24838509/Treatment_of_basilar_invagination_with_atlantoaxial_dislocation:_atlantoaxial_joint_distraction_and_fixation_with_transoral_atlantoaxial_reduction_plate__TARP__without_odontoidectomy_ L2 - https://doi.org/10.1007/s00586-014-3378-8 DB - PRIME DP - Unbound Medicine ER -