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Atlantoaxial Joint Distraction for the Treatment of Basilar Invagination: Clinical Outcomes and Radiographic Evaluation.
World Neurosurg. 2018 Mar; 111:e135-e141.WN

Abstract

OBJECTIVE

To investigate the causes of partial remission in patients with basilar invagination (BI) and irreducible atlantoaxial dislocation (IAAD) treated with transoral atlantoaxial reduction plate (TARP) without odontoidectomy and quantify the distance of odontoid descent.

METHODS

Between August 2010 and July 2012, 22 consecutive patients with BI with IAAD who underwent TARP surgery were reviewed. The preoperative and postoperative radiographic parameters were evaluated. Follow-up data and the symptom treatment interval (STI), defined as the interval between the onset of symptoms and surgical treatment, were assessed. Neurological function was evaluated as neurologic improvement, defined as ([Postoperative Japanese Orthopedic Association (JOA) score] - [Preoperative JOA score])/(17 - [Preoperative JOA score]). The patients were assigned to group A (<50%) or group B (≥50%) based on their level of neurologic improvement.

RESULTS

All 22 patients improved clinically to varying degrees. The mean preoperative STI was 105.6 ± 67.6 months for group A and 45.3 ± 46.7 months for group B (P < 0.05). There were no significant between-group differences in follow-up (P > 0.05) or with respect to radiographic parameters (P > 0.05). Persistent brainstem compression was observed in 1 patient, whose symptoms were not adequately relieved after revision surgery (transoral odontoidectomy and posterior decompression and fusion). No fixation failure was observed.

CONCLUSIONS

Descent of the odontoid process is useful for treating basilar invagination. TARP surgery without odontoidectomy may pull the dens caudally and ventrally to achieve sufficient decompression of the spinal cord. Neurologic improvement may be associated with STI.

Authors+Show Affiliations

Southern Medical University, Guangzhou, People's Republic of China; Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China.Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China. Electronic address: gzzyyspinexu@126.com.Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China.Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China.Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China.Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China.Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China.Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China.Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China.Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China.Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29248777

Citation

Lan, Sibin, et al. "Atlantoaxial Joint Distraction for the Treatment of Basilar Invagination: Clinical Outcomes and Radiographic Evaluation." World Neurosurgery, vol. 111, 2018, pp. e135-e141.
Lan S, Xu J, Wu Z, et al. Atlantoaxial Joint Distraction for the Treatment of Basilar Invagination: Clinical Outcomes and Radiographic Evaluation. World Neurosurg. 2018;111:e135-e141.
Lan, S., Xu, J., Wu, Z., Xia, H., Ma, X., Zhang, K., Ai, F., Wang, J., Yin, Q., Yi, H., & Duan, M. (2018). Atlantoaxial Joint Distraction for the Treatment of Basilar Invagination: Clinical Outcomes and Radiographic Evaluation. World Neurosurgery, 111, e135-e141. https://doi.org/10.1016/j.wneu.2017.12.013
Lan S, et al. Atlantoaxial Joint Distraction for the Treatment of Basilar Invagination: Clinical Outcomes and Radiographic Evaluation. World Neurosurg. 2018;111:e135-e141. PubMed PMID: 29248777.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Atlantoaxial Joint Distraction for the Treatment of Basilar Invagination: Clinical Outcomes and Radiographic Evaluation. AU - Lan,Sibin, AU - Xu,Junjie, AU - Wu,Zenghui, AU - Xia,Hong, AU - Ma,Xiangyang, AU - Zhang,Kai, AU - Ai,Fuzhi, AU - Wang,Jianhua, AU - Yin,Qingshui, AU - Yi,Honglei, AU - Duan,Mingyang, Y1 - 2017/12/14/ PY - 2017/07/01/received PY - 2017/12/01/revised PY - 2017/12/04/accepted PY - 2017/12/19/pubmed PY - 2018/5/19/medline PY - 2017/12/18/entrez KW - Basilar invagination KW - Decompression KW - Internal fixation KW - Transoral SP - e135 EP - e141 JF - World neurosurgery JO - World Neurosurg VL - 111 N2 - OBJECTIVE: To investigate the causes of partial remission in patients with basilar invagination (BI) and irreducible atlantoaxial dislocation (IAAD) treated with transoral atlantoaxial reduction plate (TARP) without odontoidectomy and quantify the distance of odontoid descent. METHODS: Between August 2010 and July 2012, 22 consecutive patients with BI with IAAD who underwent TARP surgery were reviewed. The preoperative and postoperative radiographic parameters were evaluated. Follow-up data and the symptom treatment interval (STI), defined as the interval between the onset of symptoms and surgical treatment, were assessed. Neurological function was evaluated as neurologic improvement, defined as ([Postoperative Japanese Orthopedic Association (JOA) score] - [Preoperative JOA score])/(17 - [Preoperative JOA score]). The patients were assigned to group A (<50%) or group B (≥50%) based on their level of neurologic improvement. RESULTS: All 22 patients improved clinically to varying degrees. The mean preoperative STI was 105.6 ± 67.6 months for group A and 45.3 ± 46.7 months for group B (P < 0.05). There were no significant between-group differences in follow-up (P > 0.05) or with respect to radiographic parameters (P > 0.05). Persistent brainstem compression was observed in 1 patient, whose symptoms were not adequately relieved after revision surgery (transoral odontoidectomy and posterior decompression and fusion). No fixation failure was observed. CONCLUSIONS: Descent of the odontoid process is useful for treating basilar invagination. TARP surgery without odontoidectomy may pull the dens caudally and ventrally to achieve sufficient decompression of the spinal cord. Neurologic improvement may be associated with STI. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/29248777/Atlantoaxial_Joint_Distraction_for_the_Treatment_of_Basilar_Invagination:_Clinical_Outcomes_and_Radiographic_Evaluation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(17)32129-0 DB - PRIME DP - Unbound Medicine ER -