Revision surgery of transoral atlantoaxial reduction plate (TARP) for the treatment of basilar invagination with atlantoaxial dislocation after posterior decompression failure
YANG Jincheng
MA Xiangyang
YIN Qingshui
XIA Hong
WU Zenghui
WANG Zhiyun
XU Junjie
CHEN Xuqiong
QIU Feng
ZHOU Xin
Abstract：Objective To evaluate clinical efficacy of revision surgery of transoral atlantoaxial reduction plate (TARP) fixation for the treatment of basilar invagination (BI) with atlantoaxial dislocation (AAD) after failed posterior decompression. Methods From September 2008 to June 2012, 30 patients who suffered from BI with AAD followed by unsuccessful posterior decompression underwent one-stage revision surgery by TARP fixation in Guangzhou General Hospital of Guangzhou Military Command. Pre- and postoperative dynamic cervical X-rays, CT and MRI were performed to assess the status of dislocation and ventral compression of cervical spinal cord. The neurological status was evaluated by Japanese Orthopaedic Association (JOA) scoring system. Results All cases underwent revision surgeries successfully. The average operative time was 150 min (120-250 min), and the intraoperative estimate blood loss was 120 mL (50-200 mL). All patients were followed up with the average time of 16 months (range, 6-39 months), and for all of the cases, satisfied decompression and reduction had been achieved, and they obtained bone fusion within 3-6 months. Atlanto-dens interval and cervicomedullary angle improved from preoperative (9.1 ± 1.4) mm, (116.5 ± 12.0)°, to postoperative (1.6 ± 1.4) mm, (149.3 ± 10.4)° respectively, there were statistical differences between preoperation and postoperation (t = 18.842, P = 0.000; t = -16.520, P = 0.000). Clinical symptoms were resolved in 29 patients and stabilised in 1 patient. JOA score increased from preoperative 10.8 ± 2.3 to 14.5 ± 1.9 at 6 months after the surgery, the difference between preoperative and postoperative results had statistical significance (t = -17.440, P = 0.000). During the follow-up, no atlantoaxial redislocation or symptom aggravation were found. Lung infection occurred in 1 case 2 weeks after the surgery, and axial screw loosening was found 1 months postoperatively, finally the patient was cured by antibiotics therapy and screw adjustment. Conclusion Considering an effective and safe method for patients suffered from BI and AAD, revision procedure of TARP internal fixation is valuable for those who confronted the difficulties of posterior fusion and internal fixation after unsuccessful posterior decompression.
Keywords：Basilar invaginationAtlanto-axial jointDislocationsTreatment failureTransoral surgeryBone platesInternal fixation
Publication Date：2014-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 197-202 )