One stage anterior release and posterior fusion for the treatment of irreducible atlantoaxial dislocation secondary to os odontoideum

任先军(Ren Xianjun，Dept Orthop，Xinqiao Hosp，3rd Mil Med Univ，Chongqing 400037)…∥Chin J Clin Basic Orthop Res.－2010，2(3).－172～175

One stage anterior release and posterior fusion for the treatment of irreducible atlantoaxial dislocation secondary to os odontoideum

任先军(Ren Xianjun，Dept Orthop，Xinqiao Hosp，3rd Mil Med Univ，Chongqing 400037)…∥Chin J Clin Basic Orthop Res.－2010，2(3).－172～175

ObjectiveTo evaluate clinical effect of the ventral release through high anterior cervical retropharyngeal approach and one stage posterior fusion for the treatment of irreducible atlantoaxial dislocation(IAAD)secondary to os odontoideum.MethodsThere were 19 patients with IAAD secondary to os odontoideum，these dislocations were unable to be reduced at X-ray radiograph dynamic position as well as preoperative skull traction.Atlantoaxial ventral release and reduction were performed by high anterior cervical retropharyngeal approach and one stage posterior atlantoaxial fusions with brooks technique were carried out.ResultsThrough high anterior cervical retropharyngeal approach，C1 anterior arch to C3 vertebral body were exposed successfully and fully reduction were achieved after ventral release in all patients.Combined with one stage atlantoaxial fusion and fixation，there were no spinal cord injury aggravation，pharyngolaryngeal obstruction or asphyxia during or after the operation.Wounds infection at the posterior neck occurred in 1 case which healed after appropriate treatment，2 patients appeared hypoglossal nerve drag symptoms and 1 case had facial nerve stimulation symptom which returned to normal after one month later.There was no nerve damage happended in patients with normal spinal cord functions，while in paralytic patients neurological functions were improved.During the follow-up，all patients achieved posterior atlantoaxial bony fusion，and no hard wear loosening occurred.ConclusionPatients with IAAD secondary to os odontoideum could be treated using the method of ventral release by high cervical retropharyngeal approach combined with one stage posterior C1-C2 fusion to achieve good reduction and atlantoaxial bony fusion.14 refs，1 fig.

(Authors)