Is anterior release and cervical traction necessary for the treatment of irreducible atlantoaxial dislocation? A systematic review and meta-analysis

  • Jian Guan
  • Zan Chen
  • Hao Wu
  • Qingyu Yao
  • Can Zhang
  • Tengfei Qi
  • Kai Wang
  • Wanru Duan
  • Jun Gao
  • Yongning Li
  • Fengzeng Jian
Review

Abstract

Purpose

To compare the clinical and radiographic outcomes of irreducible atlantoaxial dislocation (IAAD) treated with posterior fusion after anterior release and direct posterior reduction of the dislocation.

Methods

Online databases were searched for articles describing IAAD published from 1999 to 2015. Five studies (105 patients) described treatment with posterior fusion after periodontoid tissue release, and five studies (113 patients) described treatment with direct posterior reduction of the dislocation. The primary outcomes in this study were the complete reduction rate, Japanese Orthopedic Association score, perioperative morbidity, perioperative mortality, complications, vascular injury, and infection. Standard meta-analysis techniques were used to compare the outcomes.

Results

Of 319 citations examined, 10 articles involving 218 participants were eligible. Overall, there were no significant differences between the anterior release and posterior fixation (ARPF) group and direct posterior reduction and fixation (DPRF) group in the complete reduction rate, neurologic recovery rate, perioperative morbidity, perioperative mortality, vascular injury, or infection. However, the complication rate in the DPRF group was much lower than that in the ARPF group.

Conclusions

Compared with posterior fusion after anterior release, direct posterior reduction of the dislocation showed no significant differences in terms of the complete reduction rate, neurologic recovery rate, or fusion rate; however, it was a simpler process associated with less surgical trauma and a shorter operation time. Because of the limitations of the small sample in this study, whether direct posterior reduction of the dislocation is more effective and safer than posterior fusion after anterior release remains unclear.

Level of evidence

III.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Irreducible atlantoaxial dislocation Anterior release Posterior fusion Outcomes Meta-analysis 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2018_5563_MOESM1_ESM.pptx (264 kb)
Supplementary material 1 (PPTX 264 kb)

References

  1. 1.
    Yang SY et al (2014) A review of the diagnosis and treatment of atlantoaxial dislocations. Glob Spine J 4:197–210CrossRefGoogle Scholar
  2. 2.
    Venkatesan M et al (2012) Traumatic atlantoaxial rotatory subluxation (TAARS) in adults: a report of two cases and literature review. Injury 43:1212–1215CrossRefPubMedGoogle Scholar
  3. 3.
    Menezes AH et al (1980) Craniocervical abnormalities. A comprehensive surgical approach. J Neurosurg 53:444–455CrossRefPubMedGoogle Scholar
  4. 4.
    Bouchaud-Chabot A, Liote F (2002) Cervical spine involvement in rheumatoid arthritis. A review. Joint Bone Spine 69:141–154CrossRefPubMedGoogle Scholar
  5. 5.
    Salunke P et al (2011) Congenital atlantoaxial dislocation: a dynamic process and role of facets in irreducibility. J Neurosurg Spine 15:678–685CrossRefPubMedGoogle Scholar
  6. 6.
    Wang C et al (2006) Open reduction of irreducible atlantoaxial dislocation by transoral anterior atlantoaxial release and posterior internal fixation. Spine (Phila Pa 1976) 31:E306–E313CrossRefGoogle Scholar
  7. 7.
    Subin B et al (1995) Transoral anterior decompression and fusion of chronic irreducible atlantoaxial dislocation with spinal cord compression. Spine (Phila Pa 1976) 20:1233–1240CrossRefGoogle Scholar
  8. 8.
    Dickman CA et al (1992) The influence of transoral odontoid resection on stability of the craniovertebral junction. J Neurosurg 77:525–530CrossRefPubMedGoogle Scholar
  9. 9.
    Hwang SW et al (2008) C1–C2 arthrodesis after transoral odontoidectomy and suboccipital craniectomy for ventral brain stem compression in Chiari I patients. Eur Spine J 17:1211–1217CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Hao D et al (2016) Single-stage anterior release and sequential posterior fusion for irreducible atlantoaxial dislocation. Clin Spine Surg 29:E240–E245CrossRefPubMedGoogle Scholar
  11. 11.
    Srivastava SK et al (2016) Single-stage anterior release and posterior instrumented fusion for irreducible atlantoaxial dislocation with basilar invagination. Spine J 16:1–9CrossRefPubMedGoogle Scholar
  12. 12.
    Laheri V et al (2015) Anterior transoral atlantoaxial release and posterior instrumented fusion for irreducible congenital basilar invagination. Eur Spine J 24:2977–2985CrossRefPubMedGoogle Scholar
  13. 13.
    Abumi K et al (1999) Posterior occipitocervical reconstruction using cervical pedicle screws and plate-rod systems. Spine (Phila Pa 1976) 24:1425–1434CrossRefGoogle Scholar
  14. 14.
    Goel A et al (2005) Reduction of fixed atlantoaxial dislocation in 24 cases: technical note. J Neurosurg Spine 2:505–509CrossRefPubMedGoogle Scholar
  15. 15.
    Chandra PS et al (2013) Distraction, compression, and extension reduction of basilar invagination and atlantoaxial dislocation: a novel pilot technique. Neurosurgery 72:1040–1053CrossRefPubMedGoogle Scholar
  16. 16.
    Jian FZ et al (2010) Direct posterior reduction and fixation for the treatment of basilar invagination with atlantoaxial dislocation. Neurosurgery 66(678–687):687Google Scholar
  17. 17.
    Salunke P et al (2015) Technique for direct posterior reduction in irreducible atlantoaxial dislocation: multi-planar realignment of C1–2. Clin Neurol Neurosurg 131:47–53CrossRefPubMedGoogle Scholar
  18. 18.
    Suh BG et al (2013) A new technique for reduction of atlantoaxial subluxation using a simple tool during posterior segmental screw fixation: clinical article. J Neurosurg Spine 19:160–166CrossRefPubMedGoogle Scholar
  19. 19.
    Yin YH et al (2013) Posterior realignment of irreducible atlantoaxial dislocation with C1–C2 screw and rod system: a technique of direct reduction and fixation. Spine J 13:1864–1871CrossRefPubMedGoogle Scholar
  20. 20.
    Greenberg AD (1968) Atlanto-axial dislocations. Brain 91:655–684CrossRefPubMedGoogle Scholar
  21. 21.
    Wang S et al (2013) Novel surgical classification and treatment strategy for atlantoaxial dislocations. Spine (Phila Pa 1976) 38:E1348–E1356CrossRefGoogle Scholar
  22. 22.
    Qiuhang Z et al (2013) Transoral endoscopic odontoidectomy to decompress the cervicomedullary junction. Spine (Phila Pa 1976) 38:E901–E906CrossRefGoogle Scholar
  23. 23.
    Dlouhy BJ et al (2015) Evolution of transoral approaches, endoscopic endonasal approaches, and reduction strategies for treatment of craniovertebral junction pathology: a treatment algorithm update. Neurosurg Focus 38:E8CrossRefPubMedGoogle Scholar
  24. 24.
    Gempt J et al (2011) Endoscopic transnasal resection of the odontoid: case series and clinical course. Eur Spine J 20:661–666CrossRefPubMedGoogle Scholar
  25. 25.
    Radcliff K et al (2012) CT and MRI-based diagnosis of craniocervical dislocations: the role of the occipitoatlantal ligament. Clin Orthop Relat Res 470:1602–1613CrossRefPubMedGoogle Scholar
  26. 26.
    Kingdom TT et al (1995) Transoral-transpharyngeal approach to the craniocervical junction. Otolaryngol Head Neck Surg 113:393–400CrossRefPubMedGoogle Scholar
  27. 27.
    Nordt JC, Stauffer ES (1981) Sequelae of atlantoaxial stabilization in two patients with Down’s syndrome. Spine (Phila Pa 1976) 6:437–440CrossRefGoogle Scholar
  28. 28.
    Hedequist D et al (2010) Single stage reduction and stabilization of basilar invagination after failed prior fusion surgery in children with Down’s syndrome. Spine (Phila Pa 1976) 35:E128–E133CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Jian Guan
    • 1
    • 2
  • Zan Chen
    • 1
  • Hao Wu
    • 1
  • Qingyu Yao
    • 1
  • Can Zhang
    • 1
  • Tengfei Qi
    • 1
  • Kai Wang
    • 1
  • Wanru Duan
    • 1
  • Jun Gao
    • 2
  • Yongning Li
    • 2
  • Fengzeng Jian
    • 1
  1. 1.Division of Spine, Department of Neurosurgery, China International Neurological Institute, Xuanwu HospitalCapital Medical UniversityBeijingPeople’s Republic of China
  2. 2.Department of Neurosurgery, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople’s Republic of China

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