Long term outcome of endoscopic transcervical anterior release and posterior fixation in the treatment of irreducible atlantoaxial dislocation

MA Hong; WANG Bing; L Guo-hua

doi:10.3969/j.issn.2095-252X.2016.05.005

Abstract：Objective To analyze the long term outcome of endoscopic transcervical anterior release and posterior ifxation in the treatment of irreducible atlantoaxial dislocation ( IAAD ).Methods Totally 39 cases with IAAD underwent endoscopic transcervical anterior release and posterior fixation from March 2005 to July 2010. There were 16 males and 23 females with the average age of ( 36.7 ± 14.9 ) years. Eight cases had C1 occipitalization, 5 cases had rheumatoid arthritis, 21 cases had basilar invagination. Visual analoge scale ( VAS ) score for cervical pain, Japanese orthopedic association ( JOA ) score, anterior atlanto-odontoid interval ( AADI ), cervicomedullary angle ( CMA ) at preoperation, 3 months, 1 year and ifnal follow-up after surgery were reviewed statistically.Results The average follow-up period was ( 69.7 ± 7.3 ) months. As for VAS cervical pain and JOA score: signiifcant differences (P < 0.05 ) were noticed between 3 months’ follow-up and preoperation, last follow-up and 3 months’ follow-up. As for AADI and CMA, signiifcant differences (P< 0.05 ) were noticed between 3 months’ follow-up and preoperation, whereas no signiifcant differences (P > 0.05 ) were seen between last follow-up and 3 months’ follow-up. During follow-up, all cases showed improvement of neurological function, the JOA scores were improved from ( 11.6 ± 3.3 ) points preoperatively to ( 16.2 ± 2.3 ) points at last follow-up. No complication such as ifxation failure, pseudarthrosis were witnessed during follow-up. Solid fusion was confirmed by CT in all cases.Conclusions Endoscopic transcervical anterior release and posterior ifxation for IAAD can improve clinical outcomes, decrease postoperative complication as well as restore and maintain the normal atlantoaxial facet joint anatomy in long term.