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Revisiting the differences between irreducible and reducible atlantoaxial dislocation in the era of direct posterior approach and C1-2 joint manipulation.
J Neurosurg Spine. 2017 Mar; 26(3):331-340.JN

Abstract

OBJECTIVE

The current management of atlantoaxial dislocation (AAD) focuses on the C1-2 joints, commonly approached through a posterior route. The distinction between reducible AAD (RAAD) and irreducible AAD (IrAAD) seems to be less important in modern times. The roles of preoperative traction and dynamic radiographs are questionable. This study evaluated whether differentiating between the 2 groups is important in today's era.

METHODS

Ninety-six consecutive patients with congenital AAD (33 RAAD and 63 IrAAD), who underwent surgery through a posterior approach alone, were studied. The preoperative and follow-up clinical statuses for both groups were studied and compared using Japanese Orthopaedic Association (JOA) scores. The radiological findings of the 2 groups were compared, and the intraoperative challenges described.

RESULTS

A poor preoperative JOA score (clinical status) was seen in one-fifth of patients with IrAAD, although the mean JOA score was nearly similar in the RAAD and IrAAD groups. There was significant improvement in follow-up JOA score in both groups. However, segmentation defects (such as an assimilated arch of the atlas and C2-3 fusion) and anomalous vertebral arteries were found significantly more often in cases of IrAAD compared with those of RAAD. Os odontoideum was commonly seen in the RAAD group. The C1-2 joints were acute in IrAAD compared with RAAD. Preoperative traction in IrAAD resulted in vertical distraction and improvement in clinical and respiratory status. Surgery for IrAAD required much more drilling and manipulation of the C1-2 joints while safeguarding the anomalous vertebral artery.

CONCLUSIONS

Bony and vascular anomalies were much more common in patients with IrAAD, which made surgery more challenging than it was in RAAD despite similar approaches. An irreducible dislocation seen on preoperative radiographs made surgeons aware of difficulties that were likely to be encountered and helped them to better plan the surgery. Distraction achieved through preoperative traction reaffirmed the feasibility of intraoperative reduction. This made the differentiation between the 2 groups and the use of preoperative traction equally important.

Authors+Show Affiliations

Departments of 1 Neurosurgery and.Departments of 1 Neurosurgery and.Departments of 1 Neurosurgery and.Departments of 1 Neurosurgery and.Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27858533

Citation

Deepak, Arsikere N., et al. "Revisiting the Differences Between Irreducible and Reducible Atlantoaxial Dislocation in the Era of Direct Posterior Approach and C1-2 Joint Manipulation." Journal of Neurosurgery. Spine, vol. 26, no. 3, 2017, pp. 331-340.
Deepak AN, Salunke P, Sahoo SK, et al. Revisiting the differences between irreducible and reducible atlantoaxial dislocation in the era of direct posterior approach and C1-2 joint manipulation. J Neurosurg Spine. 2017;26(3):331-340.
Deepak, A. N., Salunke, P., Sahoo, S. K., Prasad, P. K., & Khandelwal, N. K. (2017). Revisiting the differences between irreducible and reducible atlantoaxial dislocation in the era of direct posterior approach and C1-2 joint manipulation. Journal of Neurosurgery. Spine, 26(3), 331-340. https://doi.org/10.3171/2016.8.SPINE16408
Deepak AN, et al. Revisiting the Differences Between Irreducible and Reducible Atlantoaxial Dislocation in the Era of Direct Posterior Approach and C1-2 Joint Manipulation. J Neurosurg Spine. 2017;26(3):331-340. PubMed PMID: 27858533.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Revisiting the differences between irreducible and reducible atlantoaxial dislocation in the era of direct posterior approach and C1-2 joint manipulation. AU - Deepak,Arsikere N, AU - Salunke,Pravin, AU - Sahoo,Sushanta K, AU - Prasad,Prashant K, AU - Khandelwal,Niranjan K, Y1 - 2016/11/18/ PY - 2016/11/20/pubmed PY - 2017/3/23/medline PY - 2016/11/19/entrez KW - AAD = atlantoaxial dislocation KW - ADI = atlantodental interval KW - BI = basilar invagination KW - C1–2 joints KW - CVJ = craniovertebral junction KW - IrAAD = irreducible AAD KW - JOA = Japanese Orthopaedic Association KW - RAAD = reducible AAD KW - VA = vertebral artery KW - VD = vertical displacement KW - anomalies KW - atlantoaxial dislocation KW - basilar invagination KW - cervical KW - differences KW - irreducible KW - reducible SP - 331 EP - 340 JF - Journal of neurosurgery. Spine JO - J Neurosurg Spine VL - 26 IS - 3 N2 - OBJECTIVE The current management of atlantoaxial dislocation (AAD) focuses on the C1-2 joints, commonly approached through a posterior route. The distinction between reducible AAD (RAAD) and irreducible AAD (IrAAD) seems to be less important in modern times. The roles of preoperative traction and dynamic radiographs are questionable. This study evaluated whether differentiating between the 2 groups is important in today's era. METHODS Ninety-six consecutive patients with congenital AAD (33 RAAD and 63 IrAAD), who underwent surgery through a posterior approach alone, were studied. The preoperative and follow-up clinical statuses for both groups were studied and compared using Japanese Orthopaedic Association (JOA) scores. The radiological findings of the 2 groups were compared, and the intraoperative challenges described. RESULTS A poor preoperative JOA score (clinical status) was seen in one-fifth of patients with IrAAD, although the mean JOA score was nearly similar in the RAAD and IrAAD groups. There was significant improvement in follow-up JOA score in both groups. However, segmentation defects (such as an assimilated arch of the atlas and C2-3 fusion) and anomalous vertebral arteries were found significantly more often in cases of IrAAD compared with those of RAAD. Os odontoideum was commonly seen in the RAAD group. The C1-2 joints were acute in IrAAD compared with RAAD. Preoperative traction in IrAAD resulted in vertical distraction and improvement in clinical and respiratory status. Surgery for IrAAD required much more drilling and manipulation of the C1-2 joints while safeguarding the anomalous vertebral artery. CONCLUSIONS Bony and vascular anomalies were much more common in patients with IrAAD, which made surgery more challenging than it was in RAAD despite similar approaches. An irreducible dislocation seen on preoperative radiographs made surgeons aware of difficulties that were likely to be encountered and helped them to better plan the surgery. Distraction achieved through preoperative traction reaffirmed the feasibility of intraoperative reduction. This made the differentiation between the 2 groups and the use of preoperative traction equally important. SN - 1547-5646 UR - https://www.unboundmedicine.com/medline/citation/27858533/Revisiting_the_differences_between_irreducible_and_reducible_atlantoaxial_dislocation_in_the_era_of_direct_posterior_approach_and_C1_2_joint_manipulation_ L2 - https://thejns.org/doi/10.3171/2016.8.SPINE16408 DB - PRIME DP - Unbound Medicine ER -