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Selection of surgical procedures for basilar invagination with atlantoaxial dislocation.
Spine J. 2016 10; 16(10):1184-1193.SJ

Abstract

BACKGROUND CONTEXT

Basilar invagination (BI) is a malformation of craniovertebral junction. However, surgical procedures on BI with atlantoaxial dislocation (AAD) remain controversial.

PURPOSE

This research aimed to investigate the selection of surgical procedures and its significance in the surgical treatment of patients with BI and AAD.

STUDY DESIGN

This was a retrospective study.

PATIENT SAMPLE

This study enrolled 33 patients who were diagnosed with BI and AAD and were followed up for at least 6 months.

OUTCOME MEASURE

All of the patients were assessed for neurologic recovery observation in terms of Japanese Orthopaedic Association scores and Odom criteria. X-ray, magnetic resonance imaging, or computed tomography scanning was used to determine reduction, compression, bone graft, and internal fixation before and after operation.

METHODS

Thirty-three patients who suffered from BI with AAD were treated in our department from July 2000 to October 2014. Preoperatively, the patients were divided into two types on the basis of whether dislocation was reduced after anesthesia and traction were performed: reducible dislocation (Type A) and irreducible dislocation (Type B). Reducible dislocation was further divided into two subtypes: full reducible dislocation (Type A1) and partial reducible dislocation (Type A2). Type A1 patients were treated with direct posterior fixation and fusion after traction and reduction. Type A2 patients received posterior atlantoaxial release, fixation, and fusion under traction. Type B patients underwent transoral atlantoaxial release, posterior fixation, and fusion.

RESULTS

There were 5 Type A1 patients, 10 Type A2 patients, and 18 Type B patients treated in accordance with the proposed scheme. Postoperatively, sufficient reduction and decompression were achieved for all cases. Two Type B patients died. Other patients were followed up from 6 months to 42 months (average=16.6 months); follow-up results showed sufficient decompression, effective fixation and fusion, and no reduction loss. The Japanese Orthopaedic Association Score increased from preoperative 4-12 (average, 7.8) to postoperative 10-17 (average, 14.3), and neurologic recovery was satisfactory.

CONCLUSIONS

Under traction, simple posterior fixation and fusion were effective for Type A patients suffering from BI with AAD; anterior atlantoaxial release and posterior fixation and fusion were effective for Type B patients with BI and AAD.

Authors+Show Affiliations

Department of Orthopaedics, The 5th People's Hospital of Shanghai Fudan University, Shanghai, China.Department of Orthopaedics, The 1st Affiliated Hospital of Xinjiang Medical University, Urmuqi, Xinjiang 830054, China.Department of Orthopaedics, The 1st Affiliated Hospital of Xinjiang Medical University, Urmuqi, Xinjiang 830054, China.Department of Orthopaedics, The 1st Affiliated Hospital of Xinjiang Medical University, Urmuqi, Xinjiang 830054, China.Department of Orthopaedics, The 1st Affiliated Hospital of Xinjiang Medical University, Urmuqi, Xinjiang 830054, China.Department of Orthopaedics, The 1st Affiliated Hospital of Xinjiang Medical University, Urmuqi, Xinjiang 830054, China.Department of Orthopaedics, The 1st Affiliated Hospital of Xinjiang Medical University, Urmuqi, Xinjiang 830054, China.Department of Orthopaedics, The 1st Affiliated Hospital of Xinjiang Medical University, Urmuqi, Xinjiang 830054, China.Department of Orthopaedics, The 1st Affiliated Hospital of Xinjiang Medical University, Urmuqi, Xinjiang 830054, China. Electronic address: wbsheng@vip.sina.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27293120

Citation

Liao, Yi, et al. "Selection of Surgical Procedures for Basilar Invagination With Atlantoaxial Dislocation." The Spine Journal : Official Journal of the North American Spine Society, vol. 16, no. 10, 2016, pp. 1184-1193.
Liao Y, Pu L, Guo H, et al. Selection of surgical procedures for basilar invagination with atlantoaxial dislocation. Spine J. 2016;16(10):1184-1193.
Liao, Y., Pu, L., Guo, H., Mai, E., Liang, W., Deng, Q., Xu, T., Sheng, J., & Sheng, W. (2016). Selection of surgical procedures for basilar invagination with atlantoaxial dislocation. The Spine Journal : Official Journal of the North American Spine Society, 16(10), 1184-1193. https://doi.org/10.1016/j.spinee.2016.06.002
Liao Y, et al. Selection of Surgical Procedures for Basilar Invagination With Atlantoaxial Dislocation. Spine J. 2016;16(10):1184-1193. PubMed PMID: 27293120.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Selection of surgical procedures for basilar invagination with atlantoaxial dislocation. AU - Liao,Yi, AU - Pu,Lati, AU - Guo,Hailong, AU - Mai,Erdan, AU - Liang,Weidong, AU - Deng,Qiang, AU - Xu,Tao, AU - Sheng,Jun, AU - Sheng,Weibin, Y1 - 2016/06/09/ PY - 2015/10/08/received PY - 2016/04/21/revised PY - 2016/06/03/accepted PY - 2016/6/14/pubmed PY - 2017/6/16/medline PY - 2016/6/14/entrez KW - Atlantoaxial dislocation KW - Basilar invagination KW - Craniovertebral anomaly KW - Reduction KW - Surgical procedure SP - 1184 EP - 1193 JF - The spine journal : official journal of the North American Spine Society JO - Spine J VL - 16 IS - 10 N2 - BACKGROUND CONTEXT: Basilar invagination (BI) is a malformation of craniovertebral junction. However, surgical procedures on BI with atlantoaxial dislocation (AAD) remain controversial. PURPOSE: This research aimed to investigate the selection of surgical procedures and its significance in the surgical treatment of patients with BI and AAD. STUDY DESIGN: This was a retrospective study. PATIENT SAMPLE: This study enrolled 33 patients who were diagnosed with BI and AAD and were followed up for at least 6 months. OUTCOME MEASURE: All of the patients were assessed for neurologic recovery observation in terms of Japanese Orthopaedic Association scores and Odom criteria. X-ray, magnetic resonance imaging, or computed tomography scanning was used to determine reduction, compression, bone graft, and internal fixation before and after operation. METHODS: Thirty-three patients who suffered from BI with AAD were treated in our department from July 2000 to October 2014. Preoperatively, the patients were divided into two types on the basis of whether dislocation was reduced after anesthesia and traction were performed: reducible dislocation (Type A) and irreducible dislocation (Type B). Reducible dislocation was further divided into two subtypes: full reducible dislocation (Type A1) and partial reducible dislocation (Type A2). Type A1 patients were treated with direct posterior fixation and fusion after traction and reduction. Type A2 patients received posterior atlantoaxial release, fixation, and fusion under traction. Type B patients underwent transoral atlantoaxial release, posterior fixation, and fusion. RESULTS: There were 5 Type A1 patients, 10 Type A2 patients, and 18 Type B patients treated in accordance with the proposed scheme. Postoperatively, sufficient reduction and decompression were achieved for all cases. Two Type B patients died. Other patients were followed up from 6 months to 42 months (average=16.6 months); follow-up results showed sufficient decompression, effective fixation and fusion, and no reduction loss. The Japanese Orthopaedic Association Score increased from preoperative 4-12 (average, 7.8) to postoperative 10-17 (average, 14.3), and neurologic recovery was satisfactory. CONCLUSIONS: Under traction, simple posterior fixation and fusion were effective for Type A patients suffering from BI with AAD; anterior atlantoaxial release and posterior fixation and fusion were effective for Type B patients with BI and AAD. SN - 1878-1632 UR - https://www.unboundmedicine.com/medline/citation/27293120/Selection_of_surgical_procedures_for_basilar_invagination_with_atlantoaxial_dislocation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1529-9430(16)30218-2 DB - PRIME DP - Unbound Medicine ER -