Transoral atlantoaxial reduction plate internal fixation for the treatment of irreducible atlantoaxial dislocation: a 2- to 4-year follow-up.
OBJECTIVE
To evaluate the mid-term outcomes of transoral atlantoaxial reduction plate (TARP) internal fixation for the treatment of irreducible atlantoaxial dislocation.


METHODS
From April 2003 to April 2005, 31 patients with irreducible atlantoaxial dislocation were treated with TARP internal fixation. The average age was 37.9 years (range, 15-69 years). The subjective symptoms, objective signs, and neurological function of the patients were assessed. Radiography and magnetic resonance imaging (MRI) were performed and the results analyzed according to the Symon and Lavender clinical standard, Japanese Orthopaedic Association (JOA) score for spinal cord function and imaging standard for spinal cord decompression.


RESULTS
Complete or almost complete anatomical reduction was obtained in all 31 patients. No screw-loosening or atlantoaxial redislocation was found in 29 cases. According to the Symon and Lavender clinical standard, 14 cases had recovered completely, 7 to mild, 6 to moderate, and 4 to severe type by final follow-up, compared to the preoperative classifications of 4 as moderate, 15 as severe, and 12 as extra severe type. The outcome for 26 patients was evaluated as excellent and in 5 as adequate. The average postoperative improvement in spinal cord function was 73.3% and of decompression of the cervical cord 92.6%. The only complication was loosening of screws in two cases with senile osteoporosis. One case underwent TARP revision surgery and the other posterior occipitocervical internal fixation. Both of them were eventually cured.


CONCLUSIONS
The TARP operation is a good choice for patients with irreducible atlantoaxial dislocation and has valuable clinical application.
Department of Orthopaedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China. yqi@medmail.com.cn
Qing-shui
QS
Yin
Fu-zhi
FZ
Ai
Kai
K
Zhang
Xiao-hong
XH
Mai
Hong
H
Xia
Zeng-hui
ZH
Wu
D000293:Adolescent; D000328:Adult; D000368:Aged; D001268:Atlanto-Axial Joint / Q000002:abnormalities / Q000473:pathology / Q000601:surgery*; D001860:Bone Plates; D019299:Decompression, Surgical / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D016268:Internal Fixators; D004204:Joint Dislocations / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013116:Spinal Cord / Q000503:physiopathology; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult