Posterior two-step distraction and reduction for basilar invagination with atlantoaxial dislocation: a novel technique for precise control of reduction degree without traction

• Published in: European spine journal 2022-10, Vol.31 (10), p.2704-2713
• Main Authors: Sheng, Xia-Qing, Liu, Hao, Meng, Yang, Wang, Bei-Yu, Ding, Chen
• Format: Article
• Language: English
• Subjects: Clinical outcomes; Compression; Dislocation; Medicine; Medicine & Public Health; Neurosurgery; Original Article; Patients; Skull; Spine (cervical); Surgical Orthopedics
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-022-07313-9

Purpose The pathological changes of basilar invagination (BI) and atlantoaxial dislocation (AAD) include vertical and horizontal dislocations. Current surgical techniques have difficulty in accurately controlling the degree of reduction in these two directions and often require preoperative traction, which increases patients’ pain, hospital stay, and medical cost. This study aimed to introduce a novel technique for accurately reducing horizontal and vertical dislocation without preoperative traction and report the radiological and clinical outcomes. Methods From 2010 to 2020, patients with BI and AAD underwent posterior two-step distraction and reduction (TSDR) and occipitocervical fixation. Radiological examination was used to evaluate the reduction degree (RD) and compression. Japanese Orthopedic Association (JOA) score was used to evaluate clinical outcome. Results A total of 55 patients with BI and AAD underwent TSDR and occipitocervical fusion. The clinical symptoms of 98.2% of them improved. JOA score increased significantly after the operation. Appropriate (50% ≤ RD