Gallie technique versus atlantoaxial screw-rod constructs in the treatment of atlantoaxial sagittal instability: a retrospective study of 49 patients

Abstract

Background: The objectives of this study are to investigate the clinical curative effect of Gallie technique and atlantoaxial screw-rod constructs (SRC) on atlantoaxial sagittal instability and determine the indication of Gallie technique.

Methods: Data of 49 patients with atlantoaxial sagittal instability from February 2008 to May 2015 were analyzed retrospectively. The visual analog scale (VAS) score and the neck disability index (NDI) were used to evaluate the curative effect. Postoperative radiological outcomes were used to evaluate the stability of atlantoaxial joint and bone fusion. Perioperative parameters such as blood loss, operation time, radiographic exposure times, and hospital expense were also recorded and analyzed.

Results: Forty-nine patients (36 men and 13 women) were included in this study. The mean age was 41.4 ± 8.9 (range from 19 to 64). All patients were followed up for 24-67 months. Among these patients, 25 of these patients underwent Gallie surgery and 24 underwent SRC surgery. The pain in the occipitocervical area of all the patients has been relieved. NDI scores and VAS scores were lower in Gallie group than in SRC group in early postoperative period. The proportion of the patients who achieved good bone fusion within 3 months after operation was 88.0% (22/25) in the Gallie group and 100% (24/24) in the SRC group. The Gallie group is lower than the SRC group in blood loss, operation time, radiographic exposure times, and hospital expense. Statistical difference was observed between the two groups.

Conclusions: For patients with atlantoaxial instability who has (1) the atlantodental interval (ADI) which is bigger than 5 mm on lateral flexion-extension X-ray, or Anderson-D'Alonzo type II odontoid fracture, (2) no asymmetry between odontoid process and lateral mass on open-mouth anterior-posterior X-ray, and (3) no dislocation of lateral mass joint on the CT 3D reconstruction, Gallie technique can be chosen as a safe and effective method if atlantoaxial reduction can be achieved preoperatively. Compared with SRC, Gallie technique can relieve the pain in the occipitocervical area earlier and it can shorten operation time and reduce intraoperative bleeding, radiographic exposure times, and hospital expense effectively. However, for patients with irreducible atlantoaxial dislocation, the Gallie technique should be used with caution.

Keywords: Atlantoaxial; Instability; Screw-rod constructs; Titanium cable.

Fig. 1

Preoperative and postoperative VAS scores. *P < 0.05

Fig. 2

Preoperative and postoperative NDI scores. *P < 0.05

Fig. 3

A 27-year-old man had old odontoid fracture caused by accident. a–d Preoperative X-ray showed fracture line was located at the bottom of odontoid (arrow), revealing an atlantoaxial instability. e–l X-ray obtained on the 1st day, the 3rd month, the 6th month, the 1st year, and the 2nd year postoperatively showed bone fusion

Fig. 4

A 46-year-old man had type II odontoid fracture caused by traffic accident. a Preoperative computed tomography (CT) showed fracture line was located at the bottom of odontoid (arrow). b Lateral radiograph obtained on the 1st day after the surgery showed the position of C1 lateral mass–C2 pedicle screws and the autogenous bone block. c, d Dynamic lateral radiographs showed bone fusion in the 3rd month postoperatively

Fig. 5

A 17-year-old woman had Os odontoideum. a Preoperative CT showed uncombined odontoid process. b, c Postoperative X-ray obtained at the 6th month after the Gallie fixation showed that there was no bridging bone around the iliac bone graft. d Lateral radiographs obtained in the 24th month after the Gallie fixation showing bone fusion

Fig. 6

A 19-year-old woman had type II odontoid fracture caused by traffic accident. a Lateral radiograph showed atlantoaxial dislocation was still present. b Lateral radiograph obtained at 1 day after the Gallie fixation showed good reduction of atlas. c, d Open-mouth and lateral radiographs obtained at 18 months after the Gallie fixation, showing bone fusion