Effects of transverse connector on reduction and fixation of atlantoaxial dislocation and basilar invagination using posterior C1–C2 screw-rod technique

Wang, Huawei; Yin, Yong; Li, Teng; Yu, Xinguang; Qiao, Guangyu

doi:10.1016/j.spinee.2019.06.021

Cited by 17 publications

(21 citation statements)

References 37 publications

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“…After reviewing titles and abstracts, 12 studies remained for full-text assessment. Following inclusion and exclusion criteria, both reviewers identified seven publications that were systematically analyzed [28,[31][32][33][34][35][36].…”

Section: Resultsmentioning

confidence: 99%

“…Neither pedicle screw instrumentation nor implantation of cross-links affected the development of the spinal canal in a negative way. Wang et al reported on 317 patients who underwent C1/2 screw-rod reduction fixation and posterior atlantoaxial facet joint release due to atlantoaxial dislocation and basilar invagination (AAD and BI) [36]. Retrospectively, 317 patients were followed-up for at least 12 months with an average age of 38.6 years (min.…”

Section: Scoliosismentioning

confidence: 99%

See 1 more Smart Citation

Does the Current State of Evidence Justify the Broad Use of Cross-Links in Dorsal Instrumentation? A Systematic Review

Heck

Oikonomidis

Prasse

et al. 2021

BioMed

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Cross-links increase the stability of screw-rod systems in biomechanical testing. The aim of this systemic review was to find evidence pertaining to the additional benefit of the implantation of cross-links in clinical practice in regard to different spinal diseases. Therefore, a systematic literature analysis of two online databases was performed according to the PRISMA statement. Inclusion criteria were prospective and retrospective studies investigating the use of cross-links in dorsal instrumentation. Biomechanical studies and case series were excluded. A total of seven retrospective studies remained for final full-text evaluation. In total, two studies each address the use of cross-links in adolescent idiopathic scoliosis, neuromuscular scoliosis or atlantoaxial fusion, one study in congenital scoliosis. In atlantoaxial fusion the additional use of cross-links may provide earlier bony fusion. In surgical treatment for pediatric scoliosis the additional use of cross-links does not provide additional benefit. Radiological outcome and complication rate did not differ in between groups. No study addressed the use of cross-links in short- or long-segment fusion due to degenerative or traumatic disorders of the spine. There is a deficiency in published literature towards the impact of cross-links in spinal surgery. The current clinical evidence data do not confirm the biomechanical advantages of cross-links in clinical practice. Further studies are needed to warrant the use of cross-links in the future.

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Section: Resultsmentioning

confidence: 99%

Section: Scoliosismentioning

confidence: 99%

Does the Current State of Evidence Justify the Broad Use of Cross-Links in Dorsal Instrumentation? A Systematic Review

Heck

Oikonomidis

Prasse

et al. 2021

BioMed

View full text Add to dashboard Cite

show abstract

“…Operative release and the pedicle screw technique have been able to achieve reduction in the dislocated atlantoaxial joint when traction reduction has been unsuccessful. [13][14][15] Therefore, considering operative release, the technique of three-dimensional CT and traumatic factors, we should distinguish atlantoaxial dislocations that can be reduced surgically from the others. In the present study, our TOI classification system is able to do that.…”

Section: Discussionmentioning

confidence: 99%

New Classification and Its Value Evaluation for Atlantoaxial Dislocation

Tan

Long

et al. 2020

Orthopaedic Surgery

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Objective To introduce the TOI classification system (the Traction reduction type [T type], Operation reduction type [O type], and Irreducible type [I type] classification system) and to determine the interobserver and intraobserver reliability of the TOI classification system. Methods Based on the characteristics of atlantoaxial dislocation (AAD), AAD was divided into Traction reduction type (T type), Operation reduction type (O type), and Irreducible type (I type). The analysis of interobserver and intraobserver agreements was done using kappa statistics. From July 2016 to January 2019, 213 AAD patients were retrospectively studied at four hospitals. Plain radiographs including extension and flexion views and three‐dimensional CT images were obtained. Twenty independent observers, including eight experienced spine specialists and 12 orthopaedic fellows from four different residency training hospitals, completed the survey. Results The classification of the TOI system was based on etiology, the course of the disease, flexion–extension X‐rays, three‐dimensional CT reconstruction, and curative effects of skull traction. Flexion–extension X‐rays demonstrating a successful reduction of the dislocated atlantoaxial joint and three‐dimensional CT images showing osseous fusion of atlantoaxial facet joints and cervical traction reveal characteristics of T‐type. Furthermore, this type can be divided into two subtypes, T1 and T2, according to the etiology and course of the disease. Unsatisfactorily reduction after 1–2 weeks of strict cervical traction, no reduction shown on flexion–extension X‐rays, and no destruction or boneless fusion of atlantoaxial facet joints demonstrated in three‐dimensional CT images are characteristics of type O. Atlantoaxial facet joint showing bone fusion or failure of reduction after cervical traction or three‐dimensional CT images showing failure of surgical release are characteristics of type I. Interobserver and intraobserver reliability of the TOI classification system were moderate (κ = 0.543) and substantial (κ = 0.658), respectively. Interobserver and intraobserver reliability of the treatment choice were moderate (κ = 0.568) and substantial (κ = 0.675), respectively. There were no significant differences in the interobserver and intraobserver reliability between experienced spine specialists and fellows for all κ‐values (P > 0.05). Conclusions The TOI classification system had satisfactory reliability and, therefore, can be applied clinically and used by less experienced surgeons. We believe TOI can help surgeons choose appropriate treatment strategies.

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“…24,25 Furthermore, to increase bony fusion, 1 or 2 cross-linkages were used to the axial stability, and finally 95.8% fusion rates were observed in our study. 26 Based on our clinical experience, there are several operative nuances of using such reduction technique. During reduction when the position of the head frame was manually changed, the position of occipital protuberance and the spinous process of the axis should keep straight to guarantee the neutrality position.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Reducible Atlantoaxial Dislocation and Basilar Invagination Using the Head Frame Reduction Technique and Atlantoaxial Arthrodesis

Yin

et al. 2020

Global Spine Journal

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Study design: Retrospective case series. Object: To evaluate the outcomes of a head frame reduction and atlantoaxial arthrodesis technique for the treatment of reducible basilar invagination (BI) and atlantoaxial dislocation (AAD). Methods: Seventy-two reducible BI and AAD cases who were treated with the head frame reduction and atlantoaxial arthrodesis technique from June 2015 to December 2018 were retrospectively analyzed. Radiological measurements including the atlantodental interval (ADI), the height of odontoid process above Chamberlain line, Wackenheim line, clivus-canal angle (CCA) and JOA score were evaluated. Results: There was no death in this series. The follow-up period ranged from 6 to 32 months (mean: 21.2 months). Radiological, complete or 90% reduction was attained and complete decompression was demonstrated in all patients. The CCA increased from 123.22 ± 8.36 preoperatively to 143.05 ± 8.79 postoperatively (P < 0.01). There was no patient found postoperative dysphagia. Neurological improvement was observed in all patients, with the JOA scores increasing from 12.53 ± 1.93 preoperatively to 16.13 ± 1.23 postoperatively (P < 0.01). Solid bony fusion was demonstrated in 69 patients at follow-up (95.8%). Conclusion: Head frame reduction technique is a simple and effective treatment which could relief neurologic compression and adjust the CCA in patients with reducible AAD and BI with lower potential risks. Atlantoaxial fixation with short segmental fixation, strong purchase and low shearing force could maintain superior stabilization. The safety and long-term efficacy of such fixation and reduction technique were favorable, which illustrated that it could be a promising treatment algorithm for such kind of disease.

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Effects of transverse connector on reduction and fixation of atlantoaxial dislocation and basilar invagination using posterior C1–C2 screw-rod technique

Cited by 17 publications

References 37 publications

Does the Current State of Evidence Justify the Broad Use of Cross-Links in Dorsal Instrumentation? A Systematic Review

Does the Current State of Evidence Justify the Broad Use of Cross-Links in Dorsal Instrumentation? A Systematic Review

New Classification and Its Value Evaluation for Atlantoaxial Dislocation

Treatment of Reducible Atlantoaxial Dislocation and Basilar Invagination Using the Head Frame Reduction Technique and Atlantoaxial Arthrodesis

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