Treatment of atlantoaxial dislocations among patients with cervical osseous or vascular abnormalities utilizing hybrid techniques
Autor: | Samantha R. Horn, Shenglin Wang, Peter G. Passias, Yinglun Tian, Bassel G. Diebo |
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Rok vydání: | 2018 |
Předmět: |
Adult
Male medicine.medical_specialty Adolescent Joint Dislocations Spinous process Spinal Cord Diseases Young Adult 03 medical and health sciences Myelopathy Postoperative Complications 0302 clinical medicine Blood loss Deformity Humans Medicine Prospective Studies 030212 general & internal medicine Child Pedicle screw Aged Retrospective Studies business.industry Atlantoaxial dislocation General Medicine Middle Aged medicine.disease Surgery Spinal Fusion Treatment Outcome medicine.anatomical_structure Atlanto-Axial Joint Cervical Vertebrae Female medicine.symptom business Complication 030217 neurology & neurosurgery Atlantoaxial fixation |
Zdroj: | Journal of Neurosurgery: Spine. 29:135-143 |
ISSN: | 1547-5654 |
Popis: | OBJECTIVEMost cervical fixations for atlantoaxial dislocation (AAD) are bilateral and symmetric; however, in the setting of osseous and vascular deformity at the craniovertebral junction, asymmetrical and hybrid fixations are used as “salvage” techniques. Because of the rarity of these cases, hybrid cervical fixations for AAD have not been fully explored. The aim of this study was to evaluate the clinical feasibility and outcomes of posterior hybrid cervical fixations for AAD.METHODSTwenty-one AAD cases were retrospectively studied; 18 had cervical myelopathy with Japanese Orthopaedic Association (JOA) scores ranging from 9 to 16 (mean 13.5). Hybrid fixation techniques included unilateral pedicle screws, transarticular screws, C-2 laminar screws, cervical lateral mass screws, and spinous process screws. During the same period, 82 AAD cases, treated using symmetric traditional fixations, were analyzed as controls.RESULTSAtlantoaxial fixation was performed in 11 cases, while occiput-cervical fixation was used in 10 cases. All cases achieved solid osseous fusion. Anatomical reduction was achieved in 20 cases (95.2%). All 18 cases with myelopathy showed postoperative improvement, with JOA scores ranging from 13 to 17 (mean 15.5). Three cases (14.2%) experienced complications, including delayed wound healing, CSF leakage, and fixation loosening. Hybrid fixation techniques showed significantly greater estimated blood loss when compared with controls (208.1 ± 19.30 ml vs 139.63 ± 8.75 ml, p = 0.001). Operative duration (125.38 ± 6.29 min vs 119.41 ± 3.77 min, p = 0.464), complication rates (14.3% vs 4.9%, p = 0.148), and JOA improvement rates (61% ± 7% vs 49% ± 4%, p = 0.161) showed no significant differences.CONCLUSIONSFor ADD with osseous or vascular deformity, posterior cervical reduction and stabilization can be achieved using hybrid techniques, resulting in comparable clinical results to symmetric traditional fixation. |
Databáze: | OpenAIRE |
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