The selection of posterior bone graft materials for atlantoaxial dislocation and the evaluation of bony fusion effect
MA Xiangyang
YANG Jincheng
QIU Feng
YIN Qingshui
XIA Hong
WU Zenghui
WANG Jianhua
AI Fuzhi
ZHANG Kai
MAI Xiaohong
Abstract：Objectives To evaluate the bony fusion effects of posterior C1-C2 screw-rods fixation with different bone graft materials for patients with atlantoaxial dislocation (AAD). Methods Under general anesthesia, 468 patients with reducible AAD treated in Guangzhou General Hospital of Guangzhou Military Command from November 2002 to July 2012, performed posterior C1-C2 screw-rods fixation which C1 screw fixation methods including pedicle screw, partial transpedicle screw or lateral mass screw fixation, and C2 screw fixation methods including pedicle screw, translaminar screw, pars screw or lateral mass screw fixation. Bone grafts were chosen as autogenous cancellous bone, allogeneic cancellous bone, and autogenous bone marrow plus allogeneic cancellous bone. The fusion was followed up by X-ray and CT scanning images. Results All 468 cases underwent the surgery successfully, and no neurovascular injuries were found during the operation. There were 2 cases of superficial wound infection which were cured after debridement and antibiotics treatment. Radiological results showed all patients achieved satisfactory reduction. Total of 447 patients were followed up for 3-72 months with an average of 39 months. Among them, autogenous cancellous bone graft were used in 405 patients, allogeneic cancellous bone graft in 27 patients, and autogenous bone marrow plus allogeneic cancellous bone in 15 patients. Clinical symptoms were found to be improved to some extent without broken screw-rods in all patients. With screw loosening, a total of 5 patients did not achieve fusion (including autogenous bone grafting in 2 patients and allogeneic bone grafting in 3 patients). One of them without atlantoaxial instability was still wearing brace and following up continuously, the other four cases were reoperated with enough autogenous cancellous bone graft and achieved solid bony fusion later. Conclusions Autogenous bone should be used in the first and revision operation for patients with AAD; When it was forced to use allogeneic cancellous bone, adding autologous bone marrow can increase bony fusion rate.
Keywords：Atlanto-axial jointDislocationsBone transplantationTransplantationhomologousautologousSpinal fusionPosterior surgeryScrew-rod fixation
Publication Date：2015-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 5-9 )