The Development of Posterior Reduction Forceps for Atlantoaxial Dislocation and Its Preliminary Application in Irreducible Atlantoaxial Dislocation

Overview

Journal Eur Spine J

Specialty Orthopedics

Date 2024 May 15

PMID 38750099

Authors

Xiangyang Ma

Xiaobao Zou

Junlin Chen

Haozhi Yang

Rencai Ma

Zexin Chen

Mandi Cai

Hong Xia

Affiliations

Soon will be listed here.

Abstract

Objective: To develop posterior reduction forceps for atlantoaxial dislocation and evaluate the preliminary clinical application of this forceps in assisting simple posterior screw-rod system reduction and fixation in the treatment of irreducible atlantoaxial dislocation.

Methods: Based on the posterior atlantoaxial screw-rod system, posterior reduction forceps was developed to assist simple posterior screw-rod system for the treatment of irreducible atlantoaxial dislocation. From January 2021 to October 2022, 10 cases with irreducible atlantoaxial dislocation were treated with this technique. The Japanese Orthopaedic Association (JOA) score was applied before and after surgery to evaluate the neurological status of the patient, and the Atlanto-dental interval (ADI) was measured before and after surgery to evaluate the atlantoaxial reduction. X-ray and CT were performed to evaluate internal fixation, atlantoaxial sequence and bone graft fusion during regular follow-up. MRI was performed to evaluate the status of atlantoaxial reduction and spinal cord compression after surgery.

Results: All 10 patients were successfully operated, and there were no complications such as spinal nerve and vascular injury. Postoperative clinical symptoms were significantly relieved in all patients, and postoperative JOA score and ADI were significantly improved compared with those before surgery (P < 0.05).

Conclusions: The developed posterior reduction forceps for atlantoaxial dislocation can assist the simple posterior screw-rod system in the treatment of irreducible atlantoaxial dislocation to avoid the release in anterior or posterior approach and reduce the difficulty of surgery. The preliminary results of this technique are satisfactory and it has a good application prospect.

Citing Articles

Introducing Angle B: A Novel Quantitative Approach for Sagittal Alignment Reduction in Atlanto-Axial Dislocation Surgery.

Cui S, Wang X, Li K, Feng H, Liu Z, Jian F Ther Clin Risk Manag. 2024; 20:789-797.

PMID: 39620050 PMC: 11607998. DOI: 10.2147/TCRM.S483075.

References

Xu J, Yin Q, Xia H, Wu Z, Ma X, Zhang K . New clinical classification system for atlantoaxial dislocation. Orthopedics. 2013; 36(1):e95-100. DOI: 10.3928/01477447-20121217-25. View

Meyer B, Kuhlen D . Atlantoaxial fusion: transarticular screws versus screw-rod constructs. World Neurosurg. 2012; 80(5):516-7. DOI: 10.1016/j.wneu.2012.11.008. View

Goel A, Laheri V . Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir (Wien). 1994; 129(1-2):47-53. DOI: 10.1007/BF01400872. View

Harms J, Melcher R . Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976). 2001; 26(22):2467-71. DOI: 10.1097/00007632-200111150-00014. View

Wang C, Yan M, Zhou H, Wang S, Dang G . Open reduction of irreducible atlantoaxial dislocation by transoral anterior atlantoaxial release and posterior internal fixation. Spine (Phila Pa 1976). 2006; 31(11):E306-13. DOI: 10.1097/01.brs.0000217686.80327.e4. View

Henriques T, Cunningham B, Olerud C, Shimamoto N, Lee G, Larsson S . Biomechanical comparison of five different atlantoaxial posterior fixation techniques. Spine (Phila Pa 1976). 2000; 25(22):2877-83. DOI: 10.1097/00007632-200011150-00007. View

Lapsiwala S, Anderson P, Oza A, Resnick D . Biomechanical comparison of four C1 to C2 rigid fixative techniques: anterior transarticular, posterior transarticular, C1 to C2 pedicle, and C1 to C2 intralaminar screws. Neurosurgery. 2006; 58(3):516-21. DOI: 10.1227/01.NEU.0000197222.05299.31. View

Stokes J, Villavicencio A, Liu P, Bray R, Johnson J . Posterior atlantoaxial stabilization: new alternative to C1-2 transarticular screws. Neurosurg Focus. 2005; 12(1):E6. DOI: 10.3171/foc.2002.12.1.7. View

Elliott R, Tanweer O, Boah A, Morsi A, Ma T, Frempong-Boadu A . Outcome comparison of atlantoaxial fusion with transarticular screws and screw-rod constructs: meta-analysis and review of literature. J Spinal Disord Tech. 2012; 27(1):11-28. DOI: 10.1097/BSD.0b013e318277da19. View

10.

Bhowmick D, Benzel E . Posterior atlantoaxial fixation with screw-rod constructs: safety, advantages, and shortcomings. World Neurosurg. 2012; 81(2):288-9. DOI: 10.1016/j.wneu.2012.10.024. View

11.

Sim H, Lee J, Park J, Mindea S, Lim J, Park J . Biomechanical evaluations of various c1-c2 posterior fixation techniques. Spine (Phila Pa 1976). 2011; 36(6):E401-7. DOI: 10.1097/BRS.0b013e31820611ba. View

12.

Xia H, Yin Q, Ai F, Ma X, Wang J, Wu Z . Treatment of basilar invagination with atlantoaxial dislocation: atlantoaxial joint distraction and fixation with transoral atlantoaxial reduction plate (TARP) without odontoidectomy. Eur Spine J. 2014; 23(8):1648-55. DOI: 10.1007/s00586-014-3378-8. View

13.

Yin Q, Ai F, Zhang K, Chang Y, Xia H, Wu Z . Irreducible anterior atlantoaxial dislocation: one-stage treatment with a transoral atlantoaxial reduction plate fixation and fusion. Report of 5 cases and review of the literature. Spine (Phila Pa 1976). 2005; 30(13):E375-81. DOI: 10.1097/01.brs.0000168374.84757.d5. View

14.

Yang J, Ma X, Xia H, Wu Z, Ai F, Yin Q . Transoral anterior revision surgeries for basilar invagination with irreducible atlantoaxial dislocation after posterior decompression: a retrospective study of 30 cases. Eur Spine J. 2014; 23(5):1099-108. DOI: 10.1007/s00586-014-3169-2. View

15.

Ren X, Gao F, Li S, Yang J, Xi Y . Treatment of irreducible atlantoaxial dislocation using one-stage retropharyngeal release and posterior reduction. J Orthop Surg (Hong Kong). 2019; 27(3):2309499019870465. DOI: 10.1177/2309499019870465. View

16.

Dong C, Yang F, Wei H, Tan M . Anterior release without odontoidectomy for irreducible atlantoaxial dislocation: transoral or endoscopic transnasal?. Eur Spine J. 2020; 30(2):507-516. DOI: 10.1007/s00586-020-06527-z. View

17.

Wang J, Xu T, Pu L, Mai E, Guo H, Sheng J . Release, reduction, and fixation of one-stage posterior approach for basilar invagination with irreducible atlantoaxial dislocation. Br J Neurosurg. 2020; 38(2):249-255. DOI: 10.1080/02688697.2020.1861217. View