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. 2019 Mar 7;14(1):75.
doi: 10.1186/s13018-019-1112-2.

Retrospective analysis of surgical outcomes for atlantoaxial subluxation

Tsuyoshi Yamada  1   2 , Toshitaka Yoshii  3 , Yu Matsukura  2 , Takuya Oyaizu  1   2 , Masato Yuasa  1 , Takashi Hirai  1 , Kyohei Sakaki  2 , Hiroyuki Inose  1 , Ichiro Torigoe  2 , Kenichiro Sakai  2 , Atsushi Okawa  1 , Yoshiyasu Arai  2
Affiliations

Retrospective analysis of surgical outcomes for atlantoaxial subluxation

Tsuyoshi Yamada et al. J Orthop Surg Res. .

Abstract

Background: Atlantoaxial subluxation (AAS) is characterized by excessive movement at the junction between the atlas (C1) and axis (C2) as a result of either a bony or ligamentous abnormality. Surgical intervention is a therapeutic choice for AAS. In addition to C1 laminectomy (LAM), surgical fixation for subluxation or instability is performed by various techniques. While surgical treatment options for AAS have increased, the outcomes of different surgical techniques remain unclear.

Methods: The authors conducted a retrospective analysis of the outcomes of 30 consecutive spinal surgeries performed for AAS patients, C1 LAM in 11 cases and C1/2 fixation in 19 cases. We investigated the correlation between the clinical outcomes and the surgical methods. We also examined the factors related to poor outcomes (the recovery rate of the Japanese Orthopedic Association score for cervical myelopathy < 40%) following AAS surgeries.

Results: From a surgical method perspective, the patients in the C1 LAM group were older than those in the C1/2 fixation group (74.6 years vs 68.0 years), and the average recovery rate from the preoperative status was as follows: the C1 LAM group, 39.4%; the C1/2 fixation group, 49.8%. The C-JOA score was significantly improved after surgery in the C1/2 fixation group (from 9.8 to 13.1 points). The fixation technique seemed to successfully reduce C1/2 displacement. Each group exhibited a slight increase in the C1/2 angle and a decrease in the C2-7 angles after the operation. A higher preoperative atlantodental interval (ADI) was associated with good outcomes after the C1/2 fixation. The postoperative ADI was significantly reduced from 8.6 mm to 3.8 mm in the good outcome group after fixation. Patients with higher C1/2 angle showed good outcomes after C1 LAM. Despite the good neurological improvement, the C1/2 fixation method showed higher complication rates compared with C1 LAM method.

Conclusions: The results of this study showed that the C1/2 fixation technique exhibited effectiveness in terms of neurological recovery. However, there was a high complication rate in surgeries for AAS, especially in the C1/2 fixation. C1 LAM would be considered for high-risk AAS cases such as elderly patients with multiple comorbidities.

Keywords: Atlantoaxial subluxation; Atlantodental interval; Fixation; Laminectomy; Spine surgery.

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Conflict of interest statement

Ethics approval and consent to participate

The current retrospective study was approved by the review board of Tokyo Medical and Dental University (1777). The informed consent was obtained for each patient.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Representative lateral view of cervical spine X-rays post-operation. a C1 laminotomy. Posterior arch of C1 is decompressed (arrow head). b Transarticular screw fixation (Magerl and Brooks technique). c C1/2 fixation using C1 lateral mass and C2 pedicle screw
See this image and copyright information in PMC

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