Novel surgical classification and treatment strategy for atlantoaxial dislocations

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2013-10, Vol.38 (21), p.E1348-E1356
• Main Authors: Wang, Shenglin, Wang, Chao, Yan, Ming, Zhou, Haitao, Dang, Gengting
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Atlanto-Axial Joint - diagnostic imaging; Atlanto-Axial Joint - surgery; Cervical Vertebrae - radiation effects; Cervical Vertebrae - surgery; Child; Child, Preschool; Female; Humans; Joint Dislocations - classification; Joint Dislocations - diagnosis; Joint Dislocations - surgery; Magnetic Resonance Imaging; Male; Middle Aged; Orthopedic Procedures - instrumentation; Orthopedic Procedures - methods; Outcome Assessment (Health Care); Reproducibility of Results; Retrospective Studies; Spinal Fusion - instrumentation; Spinal Fusion - methods; Tomography, X-Ray Computed; Traction - methods; Young Adult
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/brs.0b013e3182a1e5e4

Retrospective study of 904 patients with a diagnosis of atlantoaxial dislocation (AAD), using a novel surgical classification and treatment strategy. To describe a novel surgical classification and treatment strategy for AADs. AADs can result from a variety of etiologies, yet no comprehensive classification has been accepted that guides treatment. Because of the rarity of the cases, however, the treatment strategy has also been debated. During a period of 12 years, a total of 904 patients with a diagnosis of AAD were recruited from a single academic institution. According to the treatment algorithm that included preoperative evaluation using dynamic radiograph, reconstructive computed tomography, and skeletal traction test, the cases were classified into 4 types: I to IV. Types I and II were fused in the reduced position from a posterior approach. Type III, which were irreducible dislocations, were converted to reducible dislocations using a transoral atlantoaxial release, followed by a posterior fusion. Type IV presented with bony dislocations and required transoral osseous decompressions prior to posterior fusion. Four hundred seventy-two cases were classified as type I, 160 as type II, 268 as type III, and 4 cases as type IV. Follow-up was in the range of 2 to 12 years (average: 60.5 mo). Eight hundred and ninety-nine cases (99.4%) achieved a solid atlantoaxial fusion. Anatomic atlantoaxial reduction was achieved in 892 cases (98.7%), whereas 12 cases had a partial reduction. Neurological improvement was seen in 84.1% (512/609) of the patients with myelopathy. The overall complication rate was 9.1% (82/949). Our surgical classification and treatment strategy for AADs was applied in those 904 cases and associated with excellent clinical results with a minimal risk of complications. 4.