The use of intraoperative traction for achieving reduction of irreducible atlantoaxial dislocation caused by different craniovertebral junction pathologies

• Published in: Clinical neurology and neurosurgery 2018-12, Vol.175, p.98-105
• Main Authors: Ma, Fei, Kang, Min, Liao, Ye hui, Lee, Guang zhou, Tang, Qiang, Tang, Chao, Wang, Qing, Zhong, De jun
• Format: Article
• Language: English
• Subjects: Anesthesia; Classification; Clinical outcomes; Dislocation; Dislocations; Females; Intraoperative traction; Irreducible atlantoaxial dislocation; Neurology; Patients; Reduction; Spine (cervical); Surgery; Surgery selection; Surgical site infections
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2018.10.016

•The treatment of IAAD has not been adequately streamlined.•Intraoperative traction is a effective method to facilitate reduction of IAAD.•Intraoperative traction guides the management of IAAD caused by various etiology. To investigate the usefulness of intraoperative traction in the selection of the surgical procedure for irreducible atlantoaxial dislocation (IAAD) caused by different craniovertebral junction (CVJ) pathologies. Patients and methods: Forty-three patients who were diagnosed with IAAD and who underwent surgery between January 2008 and May 2017 in our hospital were included in the study. All of the patients received skull traction under general anesthesia. Based on the traction results, the patients underwent one of the following surgeries: posterior fixation and fusion only, posterior atlantoaxial lateral mass joint release followed by fixation and fusion, or anterior release followed by posterior fixation and fusion. The classification system was defined accordingly. The treatment efficacy was evaluated based on the improvement of clinical symptoms and radiological findings. Four patients were categorized as Type A, twenty patients as Type B1, twelve patients as Type B2, and seven patients as Type C. Thirty-seven patients (86.0%) achieved complete reduction and six patients (14.0%) achieved greater than 50% reduction. Bony fusion was achieved in all patients at 6 months after the operation. The average Japanese Orthopaedic Association (JOA) score improved from 10.2 ± 2.1 before surgery to 15.0 ± 1.2 at the final follow-up. According to the Symon clinical standard, the total effectiveness rate was 97.7%, and 72.1% of the patients showed excellent clinical outcomes. Intraoperative traction is an effective and safe method to assist the selection of surgical methods for patients with IAAD caused by different CVJ etiologies.