New clinical classification system for atlantoaxial dislocation

Abstract

The purpose of this study was to define a new clinical classification of atlantoaxial dislocation based on its clinical manifestations, namely reducible atlantoaxial dislocation (RAAD), irreducible atlantoaxial dislocation (IAAD), and fixed atlantoaxial dislocation (FAAD). A total of 107 patients with atlantoaxial dislocation were respectively treated based on this clinical classification, including 66 patients with RAAD, 39 patients with IAAD, and 2 patients with FAAD. Six of the 66 patients with RAAD with rotatory atlantoaxial dislocation were treated with traction and a cervical collar, 9 with fresh type II dens fracture were treated with cannulated screw fixation, and 51 were treated with posterior atlantoaxial or occipitocervical arthrodesis. Thirty-eight patients with IAAD received a transoral atlantoaxial reduction plate system, and 1 with a giant cell tumor was treated with lesion resection and vertebral reconstruction by a shaped titanium mesh system followed by posterior occipitocervical screw-rod fixation. The 2 patients with FAAD underwent anterior decompression and received a transoral atlantoaxial reduction plate system. Follow-up data were obtained for a minimum of 6 months. All patients' neurological symptoms improved postoperatively. Bony union was accomplished by 3-month follow-up. Donor-site infection was found in 1 patient, with no occurrence of other complications. This article proposes a new classification of atlantoaxial dislocation indicating the severity and difficulty in reduction of the atlantoaxial joint. The classification system assists with decision making regarding therapeutic options. Transoral atlantoaxial reduction plate fixation and posterior atlantoaxial screw-rod fixation are commonly performed for atlantoaxial dislocation.