Transoral Atlantoaxial Release And Reduction,Posterior Decompression,Occipital Cervical Fixation And Fusion To Treat Irreducible Craniocervical Malformation

Objective:To explore the clinical result of transoral atlantoaxial release and reduction,posterior decompression,occipital cervical fixation and fusion to treat irreducible craniocervical malformation.Method:57 patients with irreducible atlantoaxial dislocation and congenital craniocervical malformation were treated with operation from January 2012 to June 2015.All patients were under skull traction during transoral atlantoaxial release and atlas posterior arch resection after foramen magnum decompression expand occipital cervical fixation and fusion.Clinical data were collected before operation and reoperatively,1 month,3 months,6 months and 12 months after surgery.Comparing with the state before and after surgery by JOA score,odontoid over Chamberlain line distance,medullary angle,ADI,foramen magnum effective median sagittal diameter.Result:The average operative time was 5.3h,with the average blood loss 62～220ml(146±37)ml.The position of all screws was appropriate,with correct angle and length.All patients were nasogastric feeding 3to7 days after operation,discharged 2 weeks after operation.There were no severe complications such as injury to vertebral artery and spinal cord,no oropharyngeal infection.Two cases of posterior approach infection were both cured with debridement and VSD vacuum drainage.The JOA score was 6～12(8.281 ± 1.688),VAS was 0～7(3.158 ± 1.320),NDI was 8～40(28.088 ± 7.422),and the JOA score was 10～17(15.228 ± 1.389),VAS score of 0 to 4(1.316 ± 0.929),NDI score of 5 to 19(12.702 土 2.732),the difference was statistically significant(t =-30.207,24.823,23.353,P<0.05).Postoperative review of imaging findings showed that the internal fixation and stability of bone graft fusion bone fusion.The Postoperative of odontoid over Chamberlain line distance was-10.00～6.90mm(3.956 ± 2.453),CMA 137.00～159.500°(147.991±5.4180),ADI1.70～5.80mm(3.640±0.947mm),the foramen magnum effective median sagittal diameter was 25.70～32.90mm(29.918±1.792mm);the odontoid over Chamberlain line distance5.30～16.70mm(11.149±2.604);CMA 109.00～129.800(120.774±5.859°),ADI 5.30～9.10mm(7.205±1.008mm);the foramen magnum effective median sagittal diameter was 6.00～18.80mm(13.419±3.374mm),the results indicated significant differences between preoperative and postoperative(t=35.167,-163.512,189.485,-76.191,P<0.05).Conclusions:Applying transoral atlantoaxial release and reduction,posterior decompression,occipital cervical fixation and fusion to treat irreducible craniocervical malformation can significantly decrease dens,correct atlantoaxial dislocation,relieve spinal cord compression,with satisfactory results.