title: Posterior reduction and instrumentation with rod-screw construct for atlanto-axial dislocation: a single institutional study with 21 consecutive cases.
abstract: OBJECTIVE
  Atlanto-axial dislocation is one of the leading causes for occipito-cervical instability. This study aimed for investigating the clinical outcome of rod-screw construct rather than traditional posterior wiring for atlanto-axial dislocation.
  
  
  METHODS
  Twenty one consecutive atlanto-axial dislocation patients undergoing surgery in our institution from April 2008 to May 2011 were retrospectively reviewed. Posterior reduction and instrumentation between occipital/C1 lateral mass and C2 pedicle, and concomitant occipital-atlanto-axial fusion were achieved with polyaxial-screw and rod construct. Clinical outcomes and complications were analyzed postoperatively at 3, 6, and 12 months.
  
  
  RESULTS
  The satisfactory repositioning and internal fixation of the atlanto-axial joint, rigid screw placement and successful atlanto-axial fusion were confirmed in the 20 cases during follow-up. One patient died of a secondary ischemic injury to the brainstem 12 days after operation. The exception was a pediatric patient with loosened screws at 3 months follow-up postoperatively. Importantly, clinical symptoms and neurological function were significantly improved in all 20 cases during each follow-up as compared to preoperative scenarios. In addition, we noted that ischemic injury and screw detachment may be the main surgical risks.
  
  
  CONCLUSIONS
  This surgical procedure provided satisfactory reduction of the atlanto-axial joint with significant neurological improvement. Moreover, we successfully avoided complications of posterior wiring.
authors: Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, PR China.
authors: Xi-Tuan
authors: XT
authors: Ji
authors: Ang
authors: A
authors: Li
authors: Qian
authors: Q
authors: Wang
authors: Dong-Sheng
authors: DS
authors: Zhao
authors: Gang
authors: G
authors: Huang
authors: Wei-Ping
authors: WP
authors: Liu
authors: Yan
authors: Y
authors: Qu
authors: Le
authors: L
authors: Niu
authors: Zhou
authors: Z
authors: Fei
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001174:Arthrodesis / Q000379:methods; D001268:Atlanto-Axial Joint / Q000293:injuries* / Q000601:surgery*; D001863:Bone Screws; D002648:Child; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D016268:Internal Fixators; D004204:Joint Dislocations / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D019637:Orthopedic Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D020127:Recovery of Function; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Atlanto-axial dislocation; Bony fusion; Internal fixation; Reduction