Atlo-Axoid Fracture-Dislocation

ObjectiveTo observe the effects of occipitoaxial angle (O‐C2 angle, OC2A) and posterior occipitocervical angle (POCA) selection on postoperative clinical efficacy and lower cervical curvature in patients with acute acquired atlantoaxial dislocation after occipitocervical fusion (OCF).MethodsA total of 150 healthy subjects without cervical disease (healthy group) were randomly selected based on gender and age. Three spine surgeons measured the OC2A and POCA of the healthy group and averaged the values. A total of 30 patients with an average age of 51.0 years (range, 18–70 years; 16 male and 14 female) with trauma or rheumatoid arthritis (disease group) who underwent occipitocervical fusion (OCF) for atlantoaxial dislocation between January 2012 and June 2016 were reviewed. OC2A, POCA, and cervical spinal angle (CSA) were measured postoperative/soon after surgery and ambulation, and at the final follow‐up visit. The preoperative and final follow‐up visual analog scale (VAS), Japanese orthopedics association score (JOA), neck disability index (NDI), and dCSA (change of CSA from postoperative/soon after surgery and ambulation to final follow‐up) were recorded.ResultsThe values of OC2A and POCA in 150 healthy subjects were 14.5° ± 3.7° and 108.2° ± 8.1°, respectively, and the 95% confidence interval (CI) were 7.2°–21.8° and 92.3°–124.0°, respectively. There was a negative correlation between OC2A and POCA (r = −0.386, P < 0.001). There were 18 patients (group one) of ideal OC2A and POCA (both within 95% CI of the healthy group) postoperative/soon after surgery and ambulation with a mean follow‐up time of 26.3 ± 20.9 months in disease group. The remaining patients (group two) with a mean follow‐up time of 31.3 ± 21.3 months. There was no statistically significant difference in the baseline data as well as pre‐operative outcomes, including VAS score, JOA score, and NDI between the two groups. Likewise, the post‐operative outcomes in final follow‐up, including VAS and JOA score, had no distinct difference in the two groups. However, NDI (11.0 ± 2.9) in group two at the final follow‐up was significantly higher than that in group one (7.0 ± 2.3) (P < 0.001). And group two showed statistically greater dCSA (5.9 ± 7.5°) than group one (−2.3° ± 6.2°) (P = 0.003).ConclusionsThe negative correlation between OC2A and POCA plays an important role in maintaining the biodynamic balance of the occipital‐cervical region. OC2A and POCA should be controlled of a normal population in patients with acute acquired atlantoaxial dislocation during OCF, which can further improve the clinical efficacy and prevent loss of lower cervical curvature after surgery.

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“…In 1910, Pilcher firstly reported the treatment of AAD by means of occipitocervical fixation. Kraus et al .…”

Section: Discussionmentioning

confidence: 99%

Importance of the Occipitoaxial Angle and Posterior Occipitocervical Angle in Occipitocervical Fusion

Tang

Liao

et al. 2019

Orthopaedic Surgery

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“…36 Since then the indications and techniques for craniocervical fusion have grown and undergone significant refinement. While both anterior 5,7,44 and posterior approaches 1,4,[14][15][16]22,24,32,33,37,[41][42][43][50][51][52][53] have been described, the choice of fusion technique has been driven by patient pathology, anatomy, and surgeon preference.…”

Section: Discussionmentioning

confidence: 99%

Posterior occipitocervical (C0–3) fusion using polyaxial occipital condyle to cervical spine screw and rod fixation: a radiographic and cadaveric analysis

Frankel¹,

Hanley

Vandergrift³

et al. 2010

SPI

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Numerous conditions affect the occipitocervical junction requiring treatment with occipitocervical fixation. In this paper the authors present their technique of craniocervical fixation achieved with the cephalad extension of posterior C1-3 polyaxial screw and rods to polyaxial screws placed in the occipital condyles. They retrospectively analyzed occipital condyle morphology obtained from CT analyses of 40 patients with normal cervical spines, evaluated occipital condyle screw placement feasibility in 4 cadavers, and provided a case report of a 70-year-old woman with rheumatoid arthritis, basilar invagination, and atlantoaxial instability who was treated with this novel technique. Based on radiographic analysis of occipital condyle anatomy, they concluded that on average a 3.5-mm-diameter x 20- to 30-mm-long screw can be safely placed at an angle of 20-33 degrees from the sagittal plane. Overall, measuring the condylar heights (mean [+/- SD] 10.8 +/- 1.5 mm, range 8.1-15.0 mm), widths (mean 11.1 +/- 1.4 mm, range 8.5-14.2 mm), lengths (20.3 +/- 2.1 mm, range 15.4-24.6 mm), and angles (mean 32.8 +/- 5.2 degrees , range 20.2-45.8 degrees) by using CT studies is an accurate and precise method. This finding correlates with the results of prior anatomical studies of occipital condyles and is important in the planning of craniovertebral junction surgery.

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“…Occipito cervical fixation was first described by Pincher in 1910 [ 14 ]. Few studies reported good clinical and radiological outcomes with sufficient correction of deformity and high fusion rate achieved through occipito-cervical fusion by utilizing plate, screw, and rods in osseous anomalies at craniocervical junction [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Atlanto-occipital Assimilation with Basilar Invagination and Atlanto-occipital Dislocation Treated by Occipitocervical Fixation: A Rare Case Report

Pisal,

Gurnani,

Kuity

2024

jocr

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Introduction: Atlanto-occipital assimilation is the most common osseous anomaly of the cervical-occipital junction. The incidence rate of occipitalization has been reported 1.42.5/1000 children. Most of the patients are asymptomatic initially. Clinical features usually appear after 3rd decade depending on the level and degree of spinal cord compression with surrounding vital structures such as vertebral artery involvement. Hence, early definitive diagnosis and subsequent successful treatment are necessary in such cases to prevent life-threatening complications. Case Report: A 16-year-old male presented with neck pain and progressive weakness of the bilateral lower limb since the past 2 months suffering from difficulty in walking, giddiness, and numbness of his fingertips.Hoffman’s sign was positive. Plain cervical spine radiography (AP and lateral) is falsely suggestive of the absence of an atlas. MRI revealed the tip of the dens projecting 1314 mm above the Chamberlains line suggestive of basilar invagination. Occipito-cervical fixation was planned with an occipital plate, laminar, pedicle screw, and rods. Occipital plate fixed with screws (6,8 mm). C2 vertebra fixation with pedicle screw and laminar screws and C3 vertebra with a lateral mass screw under C-arm guidance.The patient mobilized with a walker from post-operative day 2 and then he ambulated unaided. Conclusion: Different types of atlanto-occipital assimilation have been reported. Treatment modality completely depends on neurological symptoms and instability.Although, different surgical options are available, occipito-cervical fixation with occipital plate, screws, and rod fixation is the most superior surgical technique for atlanto-occipital assimilation with atlanto-occipital instability. Keywords: Atlanto-occipital assimilation, basilar invagination, occipito-cervical fixation.

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Atlo-Axoid Fracture-Dislocation

Cited by 26 publications

References 0 publications

Importance of the Occipitoaxial Angle and Posterior Occipitocervical Angle in Occipitocervical Fusion

Importance of the Occipitoaxial Angle and Posterior Occipitocervical Angle in Occipitocervical Fusion

Posterior occipitocervical (C0–3) fusion using polyaxial occipital condyle to cervical spine screw and rod fixation: a radiographic and cadaveric analysis

Atlanto-occipital Assimilation with Basilar Invagination and Atlanto-occipital Dislocation Treated by Occipitocervical Fixation: A Rare Case Report

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