title: An 11-Year Review of the TARP Procedure in the Treatment of Atlantoaxial Dislocation.
abstract: METHODS
  Retrospective study.
  
  
  OBJECTIVE
  The aim of the study was to introduce the surgical techniques and evaluate the clinical outcomes of transoral atlantoaxial reduction plate (TARP) for the treatment of atlantoaxial dislocation.
  
  
  BACKGROUND
  Researchers have reported on transoral plate internal fixation for the treatment of irreducible atlantoaxial dislocation (IAAD) without long-term follow-up and detailed clinical experience.
  
  
  METHODS
  The clinical records of 388 patients with atlantoaxial dislocation (IAAD, 340 cases; fixed atlantoaxial dislocation [FAAD], 48 cases) who received the TARP procedure from April 2003 to September 2014 were retrospectively reviewed. They were treated separately with TARP-I or TARP-II (82 cases), TARP-III (248 cases), or TARP-IV (58 cases). X-ray and magnetic resonance imaging were used to evaluate the efficacy of reduction and the degree of decompression, respectively. The long-term clinical outcome was evaluated by Japanese Orthopaedic Association scoring and the Symon and Lavender standard.
  
  
  RESULTS
  Immediate reduction was achieved for all the patients with IAAD (340/340), whereas anatomical reduction was achieved for 98.2% of patients (334/340). Anatomical reduction was achieved in 87.5% of patients with FAAD (42/48). The average degree of spinal cord decompression ranged from 75% to 100% with an average of 88.4%. The clinical data of 106 patients were evaluated in the latest follow-up (12-108 mo, average 60.5 mo). The average spinal cord improvement rate by Japanese Orthopaedic Association scoring was 62.1%. According to the Symon and Lavender standard, there were 85 cases rated as markedly effective, 104 cases as effective, and 2 cases as noneffective. The overall markedly effective rate was 80% and the effective rate was 98%.
  
  
  CONCLUSIONS
  The TARP procedure showed good anterior atlantoaxial release, reduction, decompression, and internal fixation for patients with IAAD and FAAD through a single anterior approach. It has the advantages of three-dimensional immediate atlantoaxial reduction and sufficient decompression.
  
  
  METHODS
  3.
authors.affiliation: Hospital of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China.
authors.forename: Qing-Shui
authors.initials: QS
authors.lastname: Yin
authors.affiliation: Department of Orthopedic Spine Surgery, Jiangmen Central Hospital, Jiangmen, China.
authors.forename: Xue-Shi
authors.initials: XS
authors.lastname: Li
authors.affiliation: Hospital of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China.
authors.forename: Zhao-Hui
authors.initials: ZH
authors.lastname: Bai
authors.affiliation: Hospital of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China.
authors.forename: Xiao-Hong
authors.initials: XH
authors.lastname: Mai
authors.affiliation: Hospital of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Xia
authors.affiliation: Hospital of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China.
authors.forename: Zeng-Hui
authors.initials: ZH
authors.lastname: Wu
authors.affiliation: Hospital of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China.
authors.forename: Xiang-Yang
authors.initials: XY
authors.lastname: Ma
authors.affiliation: Hospital of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China.
authors.forename: Fu-Zhi
authors.initials: FZ
authors.lastname: Ai
authors.affiliation: Hospital of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China.
authors.forename: Jian-Hua
authors.initials: JH
authors.lastname: Wang
authors.affiliation: Hospital of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001268:Atlanto-Axial Joint / Q000601:surgery*; D001860:Bone Plates; D001863:Bone Screws; D002648:Child; D002675:Child, Preschool; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult