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Transoral intraarticular cage distraction and C-JAWS fixation for revision of basilar invagination with irreducible atlantoaxial dislocation.
BMC Musculoskelet Disord. 2020 Nov 20; 21(1):766.BM

Abstract

BACKGROUND

The revision surgery of basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD) after a previous occipitocervical fusion (OCF) is challenging. Transoral revision surgery has more advantages than a combined anterior and posterior approach in addressing this pathology. The C-JAWS is a cervical compressive staple that has been used in the lower cervical spine with many advantages. Up to now, there is no report on the application of C-JAWS in the atlantoaxial joint. We therefore present this report to investigate the clinical outcomes of transoral intraarticular cage distraction and C-JAWS fixation for revision of BI with IAAD.

METHODS

From June 2011 to June 2015, 9 patients with BI and IAAD were revised by this technique after previous posterior OCF in our department. Plain cervical radiographs, computed tomographic scans and magnetic resonance imaging were obtained pre- and postoperatively to assess the degree of atlantoaxial dislocation and compression of the cervical cord. The Japanese Orthopedic Association (JOA) score was used to evaluate the neurological function.

RESULTS

The revision surgeries were successfully performed in all patients. The average follow-up duration was 18.9 ± 7.3 months (range 9-30 months). The postoperative atlas-dens interval (ADI), cervicomedullary angle (CMA), distance between the top of the odontoid process and the Chamberlain line (CL) and JOA score were significantly improved in all patients (P < 0.05). Bony fusion was achieved after 3-9 months in all cases. No patients developed recurrent atlantoaxial instability.

CONCLUSIONS

Transoral revision surgery by intraarticular cage distraction and C-JAWS fixation could provide a satisfactory outcome for BI with IAAD after a previous unsuccessful posterior operation.

Authors+Show Affiliations

The First School of Clinical Medicine, Southern Medical University, No.1838 North of Guangzhou Road, Guangzhou, 510515, People's Republic of China. Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China.Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China.Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China.Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China.The First School of Clinical Medicine, Southern Medical University, No.1838 North of Guangzhou Road, Guangzhou, 510515, People's Republic of China. Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China.Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China.Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China.Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China.Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China.The First School of Clinical Medicine, Southern Medical University, No.1838 North of Guangzhou Road, Guangzhou, 510515, People's Republic of China. maxy1001@126.com. Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, No.111 Liuhua Road, Guangzhou, 510010, People's Republic of China. maxy1001@126.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33218335

Citation

Zou, Xiaobao, et al. "Transoral Intraarticular Cage Distraction and C-JAWS Fixation for Revision of Basilar Invagination With Irreducible Atlantoaxial Dislocation." BMC Musculoskeletal Disorders, vol. 21, no. 1, 2020, p. 766.
Zou X, Wang B, Yang H, et al. Transoral intraarticular cage distraction and C-JAWS fixation for revision of basilar invagination with irreducible atlantoaxial dislocation. BMC Musculoskelet Disord. 2020;21(1):766.
Zou, X., Wang, B., Yang, H., Ge, S., Ouyang, B., Chen, Y., Ni, L., Zhang, S., Xia, H., & Ma, X. (2020). Transoral intraarticular cage distraction and C-JAWS fixation for revision of basilar invagination with irreducible atlantoaxial dislocation. BMC Musculoskeletal Disorders, 21(1), 766. https://doi.org/10.1186/s12891-020-03792-3
Zou X, et al. Transoral Intraarticular Cage Distraction and C-JAWS Fixation for Revision of Basilar Invagination With Irreducible Atlantoaxial Dislocation. BMC Musculoskelet Disord. 2020 Nov 20;21(1):766. PubMed PMID: 33218335.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transoral intraarticular cage distraction and C-JAWS fixation for revision of basilar invagination with irreducible atlantoaxial dislocation. AU - Zou,Xiaobao, AU - Wang,Binbin, AU - Yang,Haozhi, AU - Ge,Su, AU - Ouyang,Bieping, AU - Chen,Yuyue, AU - Ni,Ling, AU - Zhang,Shuang, AU - Xia,Hong, AU - Ma,Xiangyang, Y1 - 2020/11/20/ PY - 2020/09/15/received PY - 2020/11/12/accepted PY - 2020/11/21/entrez PY - 2020/11/22/pubmed PY - 2021/5/15/medline KW - Basilar invagination KW - Irreducible atlantoaxial dislocation KW - Revision surgery KW - Transoral approach SP - 766 EP - 766 JF - BMC musculoskeletal disorders JO - BMC Musculoskelet Disord VL - 21 IS - 1 N2 - BACKGROUND: The revision surgery of basilar invagination (BI) with irreducible atlantoaxial dislocation (IAAD) after a previous occipitocervical fusion (OCF) is challenging. Transoral revision surgery has more advantages than a combined anterior and posterior approach in addressing this pathology. The C-JAWS is a cervical compressive staple that has been used in the lower cervical spine with many advantages. Up to now, there is no report on the application of C-JAWS in the atlantoaxial joint. We therefore present this report to investigate the clinical outcomes of transoral intraarticular cage distraction and C-JAWS fixation for revision of BI with IAAD. METHODS: From June 2011 to June 2015, 9 patients with BI and IAAD were revised by this technique after previous posterior OCF in our department. Plain cervical radiographs, computed tomographic scans and magnetic resonance imaging were obtained pre- and postoperatively to assess the degree of atlantoaxial dislocation and compression of the cervical cord. The Japanese Orthopedic Association (JOA) score was used to evaluate the neurological function. RESULTS: The revision surgeries were successfully performed in all patients. The average follow-up duration was 18.9 ± 7.3 months (range 9-30 months). The postoperative atlas-dens interval (ADI), cervicomedullary angle (CMA), distance between the top of the odontoid process and the Chamberlain line (CL) and JOA score were significantly improved in all patients (P < 0.05). Bony fusion was achieved after 3-9 months in all cases. No patients developed recurrent atlantoaxial instability. CONCLUSIONS: Transoral revision surgery by intraarticular cage distraction and C-JAWS fixation could provide a satisfactory outcome for BI with IAAD after a previous unsuccessful posterior operation. SN - 1471-2474 UR - https://www.unboundmedicine.com/medline/citation/33218335/Transoral_intraarticular_cage_distraction_and_C_JAWS_fixation_for_revision_of_basilar_invagination_with_irreducible_atlantoaxial_dislocation_ L2 - https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-020-03792-3 DB - PRIME DP - Unbound Medicine ER -