Application Of Intraarticular Bone Graft Of Unilateral Lateral Atlantoaxial Jiont In The Reconstruction Of Atlantoaxial Stability After Posterior Atlantoaxial Dumbbell-shaped Intra-extradural Tumors E

Purpose To investigate the effects of application of intraarticular bone graft of unilateral lateral atlantoaxial jiont combined with contralateral interlaminar bone graft in the reconstruction of atlantoaxial stability after posterior atlantoaxial dumbbell intra-extradural tumors excisionMethods A total of 26 patients with atlantoaxial dumbbell intra-extradural tumors were treated with internal fixation instrumentation(C2 pedicle screws and C1 lateral mass screws)and atlantoaxial fusion with bone craft in our hospital.All of patients were operated by intraarticular bone graft of unilateral lateral atlantoaxial joint combined with contralateral interlaminar bone graft.Successful fusion was determined as radiologic findings of bone fusion.We also reviewed surgical complications.instrumentation failure,bony fusion rate,atlantodens interval(ADI)and Japanese Orthopaedic Association score(JOA)Results After surgery,the symptoms of all patients significantly improved.No surgical complications were observed.According to the atandard of the fusion.postoperative bone fusion rate is 100%.No cases of instrumentation failure were observed.The mean ADI also changed significantly to2.29±0.53mm at 6 months postoperatively compared with the preoperative value of 2.28±0.6mm(P>0.95).The mean JOA score also improved significantly to 14.77±1.84 at 6 months postoperatively compared with the preoperative value of 12.35±2.9mm(P<.05)Conclusion Primary healing of incision was obtained in all patients.All patients obtained a good fusion rate by intraarticular bone graft of unilateral lateral atlantoaxial joint combined with contralateral interlaminar bone graft in patients with atlantoaxial instability.This technique can achieve the fusion of C1-C2,virtually elimating any motion and reducing the stress of the screws between them.This technique is easy to carry out in the reconstruction of the atlantoaxial dumbbell intra-extradural tumors,and the postoperative bone fusion rate is high.There are no obvious increases of blood loss and operation time.Therefore,intraarticular bone graft of unilateral lateral atlantoaxial joint combined with contralateral interlaminar bone graft can be used as a good alternative to the interlaminar bone graft fusion and a trerapy in treating atlantoaxial stability after posterior atlantoaxial dumbbell intra-extradural tumors excision.It can provide a clinical basis for the further bilateral lateral atlantoaxial articular bone graft and design of lateral atlantoaxial fusion cage.