The Effect Of C1-C2 Pedical Screw And Occipitocervical Fusion For The Treatment Of Atlantoaxial Dislocation

BackgroundAtlas and axis are in the craniovertebral junction.Craniovertebral junction is a special structure for the cranial and cervical vertebrae,which is the proximal vertebral artery,the ductibulus,and the high cervical pulp.For atlantoaxial dislocation of patients,because of atlantoaxial instability caused the compression of the spinal cord(medulla oblongata and high cervical spinal)lead to the disease,and causes high probability damage,severe cases can be life-threatening.With the development of internal fixation devices and the advances of surgical techniques,the current treatment schemes are mainly focused on the internal fixation of the pedicle screw-rod.Because the structure of the cranial neck is a special cause of operation risk and high mortality,it is the focal point and difficulty of the current research.ObjectiveObserve the effect of pedical screw and occipitocervical fusion for the treatment of atlantoaxial dislocation.MethodsRetrospective analysis of December 2012 to June 2016 in Zhengzhou University First Affiliated Hospital of neurosurgery after pedicle screw-rod fixation treatment of 55 cases of atlantoaxial dislocation patients.All patients mentioned were given informed consent before surgery,according to the choice of disease and were used the approach C1-C2 pedicle screw-rod technique and occipitocervical fusion therapy.Preoperative use of JOA score to assess the patient's neurological function,the use of X-ray,CT,3T magnetic resonance imaging,CT three-dimensional reconstruction of the patients were observed before and after atlantoaxial pedicle,atlantoaxial joint,vertebral artery and other conditions,meantime record the ADI value,CL value(distance of odontoid and CL),CMA value.According to preoperative data selection C1-C2 pedicle screw-rod technique or occipitocervical fusion for treatment.Intraoperative observation and record the amount of bleeding,operation time,atlantoaxial reduction and set nails and so on.Postoperative records of patients in general and whether the complications and so on.Follow-up of 6 to 30 months,follow-up reccorded the patient complaint,JOA assessment,SF-36 and review of CT and MRI recorded in the ADI value,CL value,CMA value,and compared with preoperative data.According to comparison of preoperative and postoperative data to determine the surgical results.ResultsOf the 55 patients enrolled,35(63.6%)received occipitocervical fusion and 20(36.6%)patients underwent C1-C2 atlantoaxial pedicle screw surgery.All patients did not experience vertebral surgery Arterial bleeding,nerve injury and other complications.Intraoperative X-ray and CT showed accurate positioning of the screw.Postoperative imaging of all patients with bone graft and internal fixation are good.All the patients were followed up for 6 to 30 months.In the patients received occipitocervical fusion,32 patients(94%)had a remission before the treatment,2 cases(6%)had no obvious remission,33(94%)had bone graft and internal fixation Good,1 case(3%)died of a large area of brain stem infarction,1 case(3%)bone fusion failed.The level of ADI decreased from preoperative(8.17 ± 2.862)mm to(2.79 ± 0.55)mm,and the CL value(8.1 ± 5.5)was increased from preoperative(10.8 ± 1.7))Decreased to(3.1 ± 1.5)mm and CMA(130.1 ± 10.3)increased to(152.7 ± 6.2)°,the difference was statistically significant(P<0.05).The last follow-up JOA score was 13.2 ± 1.7 points,which was significantly different from the preoperative and postoperative 7 days(P<0.05).In the group of which received C1-C2 atlantoaxial pedicle screw fixation,there were no significant remission in 1 patient(5%)with symptoms of C1-C2 atlantoaxial pedicle screw fixation and 19 cases(95%).All 20(100%)cases had bone graft and internal fixation.At 7 days after operation,the JOA score was increased from(11.3 ± 1.4)points to(12.1 ± 1.5)points,and the ADI value decreased from(7.13 ± 2.762)mm to(2.69 ± 0.45)mm,CL value(9.1 ± 4.6)Decreased to(3.4 ± 1.7)mm and CMA(128.1 ± 11.3)° increased to(156.7 ± 7.2)°,the difference was statistically significant(P<0.05).The last follow-up JOA score was 13.9 ± 1.4 points,which was significantly different from that before and 7 days after operation(P<0.05).By SF-36 to evaluate the quality of life in patients with preoperative and postoperative physical health and mental health,patients' quality of life was obviously improved.there are significant differences(p < 0.05)Conclusions1,C1-2 pedicle screw technique and occipitocervical fusion in the treatment of atlantoaxial dislocation are safe and effective.2,After C1-2 pedicle screw technique and occipitocervical fusion in the treatment of atlantoaxial dislocation,patients' quality of life was obviously improved.