Selection of surgical procedures for basilar invagination with atlantoaxial dislocation

Abstract

Background context: Basilar invagination (BI) is a malformation of craniovertebral junction. However, surgical procedures on BI with atlantoaxial dislocation (AAD) remain controversial.

Purpose: This research aimed to investigate the selection of surgical procedures and its significance in the surgical treatment of patients with BI and AAD.

Study design: This was a retrospective study.

Patient sample: This study enrolled 33 patients who were diagnosed with BI and AAD and were followed up for at least 6 months.

Outcome measure: All of the patients were assessed for neurologic recovery observation in terms of Japanese Orthopaedic Association scores and Odom criteria. X-ray, magnetic resonance imaging, or computed tomography scanning was used to determine reduction, compression, bone graft, and internal fixation before and after operation.

Methods: Thirty-three patients who suffered from BI with AAD were treated in our department from July 2000 to October 2014. Preoperatively, the patients were divided into two types on the basis of whether dislocation was reduced after anesthesia and traction were performed: reducible dislocation (Type A) and irreducible dislocation (Type B). Reducible dislocation was further divided into two subtypes: full reducible dislocation (Type A1) and partial reducible dislocation (Type A2). Type A1 patients were treated with direct posterior fixation and fusion after traction and reduction. Type A2 patients received posterior atlantoaxial release, fixation, and fusion under traction. Type B patients underwent transoral atlantoaxial release, posterior fixation, and fusion.

Results: There were 5 Type A1 patients, 10 Type A2 patients, and 18 Type B patients treated in accordance with the proposed scheme. Postoperatively, sufficient reduction and decompression were achieved for all cases. Two Type B patients died. Other patients were followed up from 6 months to 42 months (average=16.6 months); follow-up results showed sufficient decompression, effective fixation and fusion, and no reduction loss. The Japanese Orthopaedic Association Score increased from preoperative 4-12 (average, 7.8) to postoperative 10-17 (average, 14.3), and neurologic recovery was satisfactory.

Conclusions: Under traction, simple posterior fixation and fusion were effective for Type A patients suffering from BI with AAD; anterior atlantoaxial release and posterior fixation and fusion were effective for Type B patients with BI and AAD.

Keywords: Atlantoaxial dislocation; Basilar invagination; Craniovertebral anomaly; Reduction; Surgical procedure.