Treatment of basilar invagination with atlantoaxial dislocation: atlantoaxial joint distraction and fixation with transoral atlantoaxial reduction plate (TARP) without odontoidectomy

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• 作者：Hong Xia (1)
  QingShui Yin (1)
  FuZhi Ai (1)
  XiangYang Ma (1)
  JianHua Wang (1)
  ZengHui Wu (1)
  Kai Zhang (1)
  JingFa Liu (1)
  JunJie Xu (1)
  
• 关键词：Transoral ; Basilar invagination ; Atlantoaxial dislocation ; Arthrodesis ; Internal fixation
• 刊名：European Spine Journal
• 出版年：2014
• 出版时间：August 2014
• 年：2014
• 卷：23
• 期：8
• 页码：1648-1655
• 全文大小：709 KB
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• 作者单位：Hong Xia (1)
  QingShui Yin (1)
  FuZhi Ai (1)
  XiangYang Ma (1)
  JianHua Wang (1)
  ZengHui Wu (1)
  Kai Zhang (1)
  JingFa Liu (1)
  JunJie Xu (1)
  
  1. Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command (Liuhuaqiao Hospital), No.111 Liuhua Avenue, Guangzhou, People’s Republic of China
  
• ISSN：1432-0932

文摘

Purpose Although direct transoral decompression and one-stage posterior instrumentation can obtain satisfactory cord decompression for the treatment of basilar invagination with atlantoaxial dislocation, surgical injuries run high as combinative anterior-posterior approaches were necessary. Furthermore, the complications will rise notably when involvement of dens and/or clivus in the decompression necessitates relatively complicated surgical techniques. First initiated in 2005, transoral atlantoaxial reduction plate (TARP) works as an internal fixation for the treatment of basilar invagination with irreducible atlantoaxial dislocation. Therefore, this article aimed to describe several operative experiences about this approach, which has delivered successful decompression, fixation and fusion. Methods 21 consecutive patients with basilar invagination underwent the TARP operation. The pre- and postoperative medulla-cervical angles were measured and compared. The JOA scores of spinal cord function were calculated pre- and post-operatively. 20 cases (20/21) were followed up to average 12.5?months. Results Symptoms of all the 20 cases were relieved in different degrees. The postoperative imaging showed the odontoid processes obtained ideal reduction and the internal fixators were all in good position. The medulla-cervical angle was correctd from an average (±?standard deviation) 128.7°?+?11.9° (n?=?20) before surgery to 156.5°?+?8.1° (n?=?20) after surgery (P?n?=?20) and 15.9 (n?=?20), respectively, indicating 76?% improvement. Screw-loosening was observed in one patient due to severe osteoporosis. After a revised operation with a TARP in another size, the neurological symptoms showed no obvious improvements. Then the treatment was terminated. Conclusions The TARP operation and intra-operative traction could reduce the odontoid process superiorly migrating into the foramen magnum, directly ease the ventral compression of spinal cord, and fix the reduced atlantoaxial joints through a single transoral approach without the need of a posterior operation. In this stury, 21 patients were evaluated and 20 did well with TARP operation. The preliminary clinical result was satisfactory.