Atlantoaxial joint release through anterior retrophayngeal approach and staged posterior reduction fixation and fusion for irreducible atlantoaxial dislocation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YUAN Yang ^1,2 , LEI Fei ³ ,  ZHOU Chunguang ¹ , LIU Limin ¹ , SONG Yueming ¹

1. Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
2. Department of Orthopaedics, the People’s Hospital of Pengzhou, Pengzhou Sichuan, 611930, P.R.China;
3. Department of Spinal Surgery, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;

Corresponding author：

ZHOU Chunguang, Email: zhouchunguang@aliyun.com

Keywords：

Atlantoaxial dislocation; anterior retrophayngeal approach; anterior release; posterior fusion

DOI：

10.7507/1002-1892.201712121

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Objective To discuss the effectiveness of atlantoaxial joint release through anterior retrophayngeal approach and staged posterior reduction fixation and fusion for irreducible atlantoaxial dislocation (IAAD). Methods Fifteen patients with IAAD (9 males, 6 females), aged 14-53 years (mean, 31.4 years) were included in the study. The disease duration was 3 months to 17 years (mean, 5.7 years). IAAD was attributed to trauma in 13 cases, and 2 cases were caused by congenital odontoid disconnection. Preoperative imaging examination showed atlantoaxial dislocation and could not be reset automatically in functional position. The preoperative visual analogue scale (VAS) score was 3-7 (mean, 4.1), and the preoperative Japanese Orthopaedic Association (JOA) score was 10-17 (mean, 13.8). All patients received atlantoaxial joint release through anterior retrophayngeal approach and staged posterior fixation and fusion. Results Anatomical reduction was achieved in all 15 patients, and the alignment of atlantoaxial joints was restored. After operation, the neck pain and neurological symptom were partially or fully improved in all patients, without deterioration of neurological function. One patient developed pharyngeal discomfort and cough after one-stage operation, 4 patients developed pharyngeal discomfort and foreign body sensation after operation, and 2 patients developed pin-path lipstick swelling during skull traction. All patients were cured by symptomatic treatment. No pulmonary infection, pressure ulcers, venous thrombosis, and incision infection was found during the treatment. All 15 patients were followed up 24-36 months, with an average of 28.6 months. Bony fusion was achieved in all patients, and the fusion time was 3-5 months, with an average of 3.6 months. At last follow-up, the VAS score was 0-2 (mean, 0.5) and the JOA score was 13-17 (mean, 15.9). There was no dislocation, recurrence, or other abnormal sign in the cervical X-ray films and three-dimensional CT. Conclusion Anatomical reduction can be achieved by atlantoaxial joint release through anterior retrophayngeal approach and staged posterior fixation and fusion for treating IAAD. It is an optional procedure for IAAD.

Citation： YUAN Yang, LEI Fei, ZHOU Chunguang, LIU Limin, SONG Yueming. Atlantoaxial joint release through anterior retrophayngeal approach and staged posterior reduction fixation and fusion for irreducible atlantoaxial dislocation. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(11): 1377-1381. doi: 10.7507/1002-1892.201712121 Copy

1.	章凯, 王智运, 尹庆水. 难复型寰枢椎脱位经口咽入路手术治疗进展. 中华创伤骨科杂志, 2006, 8(12): 1175-1179.
2.	党耕町. 寰枢椎脱位的外科治疗进展. 中华外科杂志, 2004, 42(1): 27-29.
3.	王超, 阎明, 周海涛, 等. 难复性寰枢关节脱位的手术治疗. 中华骨科杂志, 2004, 24(5): 290-294.
4.	徐峰, 蔡贤华, 陈庄洪, 等. 一期前方咽后入路松解后路融合治疗难复性寰枢椎脱位. 中国临床神经外科杂志, 2011, 16(11): 656-659.
5.	陈琪, 宋跃明, 刘立岷, 等. 前后联合入路治疗陈旧性寰枢椎旋转脱位合并侧块关节绞锁. 中华骨科杂志, 2015, 35(5): 488-494.
6.	任先军, 王卫东, 蒋涛. Ⅰ期前后路联合手术治疗游离齿突继发的难复性寰枢椎脱位. 中国骨科临床与基础研究杂志, 2010, 2(3): 172-175.
7.	宋跃明. 难复性寰枢椎脱位的外科治疗. 中国骨科临床与基础研究杂志, 2010, 2(3): 167-171.
8.	尹庆水, 刘景发, 夏虹, 等. 经口咽前、后路一期手术治疗难复性寰枢椎脱位伴脊髓压迫症. 中国脊柱脊髓杂志, 2001, 11(2): 100-102.
9.	王超, 阎明, 周海涛, 等. 前路松解复位后路内固定治疗难复性寰枢关节脱位. 中国脊柱脊髓杂志, 2003, 13(10): 583-586.
10.	庄青山, 夏德涛, 葛吉玉, 等. 经口咽前路松解复位后路椎弓根螺钉内固定治疗难复性寰枢椎脱位. 中国脊柱脊髓杂志, 2009, 19(6): 427-430.
11.	Jones DC, Hayter JP, Vaugan ED, et al. Oropharyngereal morbility following transoral approaches to the upper cervical spine. Int J Maxillofac Surg, 1998, 27(4): 295-298.
12.	Hao D, He B, Zheng Y, et al. Single stage anterior release and sequential posterior fusion for irreducible atlantoaxial dislocation. Clin Spine Surg, 2016, 29(5): E240-245.
13.	闫明, 王超, 王圣林, 等. 经口咽入路寰枢关节松解复位术后发生的败血症 (附 4 例报道). 中国脊柱脊髓杂志, 2009, 19(12): 920-926.
14.	Fang HSY, Ong GB. Direct approach to the upper cervical spine. J Bone Joint Surg (Am), 1962, 44(8): 1588-1604.
15.	唐国军, 万炜. 难复性寰枢椎脱位的治疗进展. 现代生物医学进展, 2012, 12(30): 5957-5961.
16.	Park SH, Sung JK, Lee SH, et al. High anterior cervical approach to the upper cervical spine. Surg Neurol, 2007, 68(5): 519-524.
17.	Vender JR, Harrison SJ, McDonnell DE. Fusion and instrumentation at C1-3 via the high anterior cervical approach. J Neurosurg, 2000, 92(1 Suppl): 24-29.
18.	Richter MS, Schmidt R, Claes L, et al. Posterior atlantoaxial fixation: biomechanical in vitro comparison of six different echniques. Spine (Phila Pa 1976), 2002, 27(16): 1724-1732.

1. 章凯, 王智运, 尹庆水. 难复型寰枢椎脱位经口咽入路手术治疗进展. 中华创伤骨科杂志, 2006, 8(12): 1175-1179.
2. 党耕町. 寰枢椎脱位的外科治疗进展. 中华外科杂志, 2004, 42(1): 27-29.
3. 王超, 阎明, 周海涛, 等. 难复性寰枢关节脱位的手术治疗. 中华骨科杂志, 2004, 24(5): 290-294.
4. 徐峰, 蔡贤华, 陈庄洪, 等. 一期前方咽后入路松解后路融合治疗难复性寰枢椎脱位. 中国临床神经外科杂志, 2011, 16(11): 656-659.
5. 陈琪, 宋跃明, 刘立岷, 等. 前后联合入路治疗陈旧性寰枢椎旋转脱位合并侧块关节绞锁. 中华骨科杂志, 2015, 35(5): 488-494.
6. 任先军, 王卫东, 蒋涛. Ⅰ期前后路联合手术治疗游离齿突继发的难复性寰枢椎脱位. 中国骨科临床与基础研究杂志, 2010, 2(3): 172-175.
7. 宋跃明. 难复性寰枢椎脱位的外科治疗. 中国骨科临床与基础研究杂志, 2010, 2(3): 167-171.
8. 尹庆水, 刘景发, 夏虹, 等. 经口咽前、后路一期手术治疗难复性寰枢椎脱位伴脊髓压迫症. 中国脊柱脊髓杂志, 2001, 11(2): 100-102.
9. 王超, 阎明, 周海涛, 等. 前路松解复位后路内固定治疗难复性寰枢关节脱位. 中国脊柱脊髓杂志, 2003, 13(10): 583-586.
10. 庄青山, 夏德涛, 葛吉玉, 等. 经口咽前路松解复位后路椎弓根螺钉内固定治疗难复性寰枢椎脱位. 中国脊柱脊髓杂志, 2009, 19(6): 427-430.
11. Jones DC, Hayter JP, Vaugan ED, et al. Oropharyngereal morbility following transoral approaches to the upper cervical spine. Int J Maxillofac Surg, 1998, 27(4): 295-298.
12. Hao D, He B, Zheng Y, et al. Single stage anterior release and sequential posterior fusion for irreducible atlantoaxial dislocation. Clin Spine Surg, 2016, 29(5): E240-245.
13. 闫明, 王超, 王圣林, 等. 经口咽入路寰枢关节松解复位术后发生的败血症 (附 4 例报道). 中国脊柱脊髓杂志, 2009, 19(12): 920-926.
14. Fang HSY, Ong GB. Direct approach to the upper cervical spine. J Bone Joint Surg (Am), 1962, 44(8): 1588-1604.
15. 唐国军, 万炜. 难复性寰枢椎脱位的治疗进展. 现代生物医学进展, 2012, 12(30): 5957-5961.
16. Park SH, Sung JK, Lee SH, et al. High anterior cervical approach to the upper cervical spine. Surg Neurol, 2007, 68(5): 519-524.
17. Vender JR, Harrison SJ, McDonnell DE. Fusion and instrumentation at C1-3 via the high anterior cervical approach. J Neurosurg, 2000, 92(1 Suppl): 24-29.
18. Richter MS, Schmidt R, Claes L, et al. Posterior atlantoaxial fixation: biomechanical in vitro comparison of six different echniques. Spine (Phila Pa 1976), 2002, 27(16): 1724-1732.

Chinese Journal of Reparative and Reconstructive Surgery

Atlantoaxial joint release through anterior retrophayngeal approach and staged posterior reduction fixation and fusion for irreducible atlantoaxial dislocation

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