Role of Posterior Interfacetal Distraction and Grafting in Complex Atlantoaxial Dislocation

Background Data: Atlantoaxial fixation, unlike subaxial spine, is still challenging due to complex topographical anatomy. Nowadays, atlas lateral mass screws and transpedicular axis screws fixation is a well-accepted technique for the management of atlantoaxial instability due to their rigid fixatio...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Mohamed Ali El-Gaidi, MD., Mohamed Fawzy Khattab, MD.
Formato:	article
Lenguaje:	EN
Publicado:	Egyptian Spine Association 2019
Materias:	atlantoaxial dislocation basilar invagination irreducible facet joint distraction Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/e75e24f6b91c49259523e65dc48ba2f4
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:e75e24f6b91c49259523e65dc48ba2f4
record_format	dspace
spelling	oai:doaj.org-article:e75e24f6b91c49259523e65dc48ba2f42021-12-02T12:09:37ZRole of Posterior Interfacetal Distraction and Grafting in Complex Atlantoaxial Dislocation10.21608/esj.2020.20148.11152314-89502314-8969https://doaj.org/article/e75e24f6b91c49259523e65dc48ba2f42019-07-01T00:00:00Zhttps://www.esj.journals.ekb.eg/article_75852.htmlhttps://doaj.org/toc/2314-8950https://doaj.org/toc/2314-8969Background Data: Atlantoaxial fixation, unlike subaxial spine, is still challenging due to complex topographical anatomy. Nowadays, atlas lateral mass screws and transpedicular axis screws fixation is a well-accepted technique for the management of atlantoaxial instability due to their rigid fixation and higher fusion rate. However, in complex cases like basilar invagination, further reduction and proper bony alignment are needed. Study Design: A retrospective descriptive clinical case series. Objective: The aim of this study was to assess the safety and efficiency of bilateral posterior atlantoaxial facet joint distraction and insertion of spacer in reducing complex cases of atlantoaxial instability. Patients and Methods: Out of 17 patients with atlantoaxial instability, five patients underwent posterior fixation and atlantoaxial facet joint distraction and insertion of spacer for reduction of irreducible atlantoaxial dislocation. Clinical results were evaluated by using the criteria of Japanese Orthopaedic Association Scoring System for Cervical Myelopathy (JOA score). The surgical technique, results, and morbidity and mortality were assessed. Results: There were 3 females and 2 males; the age ranged from 10–50 years. The cause of significant instability was trauma (2 patients), while each of the 3 other patients suffered from Down syndrome, rheumatoid arthritis, and posttuberculous infection. All 5 patients had pyramidal tract compression manifestations. At the end of follow-up (mean 18 months), the average preoperative JOA score improved from 13.2±1 to 15.9±0.2 (P=0.04) and the average recovery rate was 69±12 % SD. Postoperative CT scans showed that the mean atlantodens interval improved from 6.2±1.6 to 1.8±0.8 (P=0.04) and the mean clivus-canal angle increased from 119.8±3.7° to 135.2±7°(P=0.04). The average extra time and blood loss of bilateral facet distraction and grafting were about 65 ml (P=0.004) and 72.5 ml, respectively. There was no mortality, vertebral artery injury, CSF leak, or construct failure. Conclusions: Bilateral posterior atlantoaxial facet joint distraction and placement of spacer is a safe and effective adjunct procedure for reduction of complex atlantoaxial instability. (2019ESJ184) Mohamed Ali El-Gaidi, MD. Mohamed Fawzy Khattab, MD.Egyptian Spine Associationarticleatlantoaxial dislocationbasilar invaginationirreduciblefacet joint distractionNeurology. Diseases of the nervous systemRC346-429ENEgyptian Spine Journal, Vol 31, Iss 1, Pp 45-53 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	atlantoaxial dislocation basilar invagination irreducible facet joint distraction Neurology. Diseases of the nervous system RC346-429
spellingShingle	atlantoaxial dislocation basilar invagination irreducible facet joint distraction Neurology. Diseases of the nervous system RC346-429 Mohamed Ali El-Gaidi, MD. Mohamed Fawzy Khattab, MD. Role of Posterior Interfacetal Distraction and Grafting in Complex Atlantoaxial Dislocation
description	Background Data: Atlantoaxial fixation, unlike subaxial spine, is still challenging due to complex topographical anatomy. Nowadays, atlas lateral mass screws and transpedicular axis screws fixation is a well-accepted technique for the management of atlantoaxial instability due to their rigid fixation and higher fusion rate. However, in complex cases like basilar invagination, further reduction and proper bony alignment are needed. Study Design: A retrospective descriptive clinical case series. Objective: The aim of this study was to assess the safety and efficiency of bilateral posterior atlantoaxial facet joint distraction and insertion of spacer in reducing complex cases of atlantoaxial instability. Patients and Methods: Out of 17 patients with atlantoaxial instability, five patients underwent posterior fixation and atlantoaxial facet joint distraction and insertion of spacer for reduction of irreducible atlantoaxial dislocation. Clinical results were evaluated by using the criteria of Japanese Orthopaedic Association Scoring System for Cervical Myelopathy (JOA score). The surgical technique, results, and morbidity and mortality were assessed. Results: There were 3 females and 2 males; the age ranged from 10–50 years. The cause of significant instability was trauma (2 patients), while each of the 3 other patients suffered from Down syndrome, rheumatoid arthritis, and posttuberculous infection. All 5 patients had pyramidal tract compression manifestations. At the end of follow-up (mean 18 months), the average preoperative JOA score improved from 13.2±1 to 15.9±0.2 (P=0.04) and the average recovery rate was 69±12 % SD. Postoperative CT scans showed that the mean atlantodens interval improved from 6.2±1.6 to 1.8±0.8 (P=0.04) and the mean clivus-canal angle increased from 119.8±3.7° to 135.2±7°(P=0.04). The average extra time and blood loss of bilateral facet distraction and grafting were about 65 ml (P=0.004) and 72.5 ml, respectively. There was no mortality, vertebral artery injury, CSF leak, or construct failure. Conclusions: Bilateral posterior atlantoaxial facet joint distraction and placement of spacer is a safe and effective adjunct procedure for reduction of complex atlantoaxial instability. (2019ESJ184)
format	article
author	Mohamed Ali El-Gaidi, MD. Mohamed Fawzy Khattab, MD.
author_facet	Mohamed Ali El-Gaidi, MD. Mohamed Fawzy Khattab, MD.
author_sort	Mohamed Ali El-Gaidi, MD.
title	Role of Posterior Interfacetal Distraction and Grafting in Complex Atlantoaxial Dislocation
title_short	Role of Posterior Interfacetal Distraction and Grafting in Complex Atlantoaxial Dislocation
title_full	Role of Posterior Interfacetal Distraction and Grafting in Complex Atlantoaxial Dislocation
title_fullStr	Role of Posterior Interfacetal Distraction and Grafting in Complex Atlantoaxial Dislocation
title_full_unstemmed	Role of Posterior Interfacetal Distraction and Grafting in Complex Atlantoaxial Dislocation
title_sort	role of posterior interfacetal distraction and grafting in complex atlantoaxial dislocation
publisher	Egyptian Spine Association
publishDate	2019
url	https://doaj.org/article/e75e24f6b91c49259523e65dc48ba2f4
work_keys_str_mv	AT mohamedalielgaidimd roleofposteriorinterfacetaldistractionandgraftingincomplexatlantoaxialdislocation AT mohamedfawzykhattabmd roleofposteriorinterfacetaldistractionandgraftingincomplexatlantoaxialdislocation
_version_	1718394664106590208

Role of Posterior Interfacetal Distraction and Grafting in Complex Atlantoaxial Dislocation

Ejemplares similares