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
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References
Yang SY et al (2014) A review of the diagnosis and treatment of atlantoaxial dislocations. Glob Spine J 4:197–210
Venkatesan M et al (2012) Traumatic atlantoaxial rotatory subluxation (TAARS) in adults: a report of two cases and literature review. Injury 43:1212–1215
Menezes AH et al (1980) Craniocervical abnormalities. A comprehensive surgical approach. J Neurosurg 53:444–455
Bouchaud-Chabot A, Liote F (2002) Cervical spine involvement in rheumatoid arthritis. A review. Joint Bone Spine 69:141–154
Salunke P et al (2011) Congenital atlantoaxial dislocation: a dynamic process and role of facets in irreducibility. J Neurosurg Spine 15:678–685
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–E313
Subin B et al (1995) Transoral anterior decompression and fusion of chronic irreducible atlantoaxial dislocation with spinal cord compression. Spine (Phila Pa 1976) 20:1233–1240
Dickman CA et al (1992) The influence of transoral odontoid resection on stability of the craniovertebral junction. J Neurosurg 77:525–530
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 17:1211–1217
Hao D et al (2016) Single-stage anterior release and sequential posterior fusion for irreducible atlantoaxial dislocation. Clin Spine Surg 29:E240–E245
Srivastava SK et al (2016) Single-stage anterior release and posterior instrumented fusion for irreducible atlantoaxial dislocation with basilar invagination. Spine J 16:1–9
Laheri V et al (2015) Anterior transoral atlantoaxial release and posterior instrumented fusion for irreducible congenital basilar invagination. Eur Spine J 24:2977–2985
Abumi K et al (1999) Posterior occipitocervical reconstruction using cervical pedicle screws and plate-rod systems. Spine (Phila Pa 1976) 24:1425–1434
Goel A et al (2005) Reduction of fixed atlantoaxial dislocation in 24 cases: technical note. J Neurosurg Spine 2:505–509
Chandra PS et al (2013) Distraction, compression, and extension reduction of basilar invagination and atlantoaxial dislocation: a novel pilot technique. Neurosurgery 72:1040–1053
Jian FZ et al (2010) Direct posterior reduction and fixation for the treatment of basilar invagination with atlantoaxial dislocation. Neurosurgery 66(678–687):687
Salunke P et al (2015) Technique for direct posterior reduction in irreducible atlantoaxial dislocation: multi-planar realignment of C1–2. Clin Neurol Neurosurg 131:47–53
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 19:160–166
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 13:1864–1871
Greenberg AD (1968) Atlanto-axial dislocations. Brain 91:655–684
Wang S et al (2013) Novel surgical classification and treatment strategy for atlantoaxial dislocations. Spine (Phila Pa 1976) 38:E1348–E1356
Qiuhang Z et al (2013) Transoral endoscopic odontoidectomy to decompress the cervicomedullary junction. Spine (Phila Pa 1976) 38:E901–E906
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:E8
Gempt J et al (2011) Endoscopic transnasal resection of the odontoid: case series and clinical course. Eur Spine J 20:661–666
Radcliff K et al (2012) CT and MRI-based diagnosis of craniocervical dislocations: the role of the occipitoatlantal ligament. Clin Orthop Relat Res 470:1602–1613
Kingdom TT et al (1995) Transoral-transpharyngeal approach to the craniocervical junction. Otolaryngol Head Neck Surg 113:393–400
Nordt JC, Stauffer ES (1981) Sequelae of atlantoaxial stabilization in two patients with Down’s syndrome. Spine (Phila Pa 1976) 6:437–440
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–E133
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Guan, J., Chen, Z., Wu, H. et al. Is anterior release and cervical traction necessary for the treatment of irreducible atlantoaxial dislocation? A systematic review and meta-analysis. Eur Spine J 27, 1234–1248 (2018). https://doi.org/10.1007/s00586-018-5563-7
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DOI: https://doi.org/10.1007/s00586-018-5563-7