Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India.
Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bangalore, India.
World Neurosurg. 2021 Feb;146:e313-e322. doi: 10.1016/j.wneu.2020.10.082. Epub 2020 Oct 20.
To evaluate the results of surgery for congenital craniovertebral junction (CVJ) anomalies with atlantoaxial dislocation (AAD)/basilar invagination (BI) and compare the results of transoral odontoidectomy and posterior fusion (TOO+PF) with only posterior fusion (PF) in patients with irreducible AAD/BI.
All 94 patients with congenital CVJ anomalies with AAD/BI operated on during the 3-year study period (June 2013-May 2016) were included. Of these patients, 55 had irreducible AAD/BI and the remaining 39 had reducible AAD/BI. TOO+PF was restricted to patients (34/94; 36.2%) with irreducible AAD/BI when reduction and realignment by intraoperative C1-C2 facet joint manipulation were considered technically difficult and risky. The remaining patients with irreducible AAD/BI and all the patients with reducible AAD/BI (60/94; 63.8%) were managed with only posterior fusion. Poor preoperative Nurick grade, preoperative dyspnea/lower cranial nerve deficits, and syringomyelia were associated with significantly higher incidence of postoperative pulmonary complications. Follow-up ≥3 months (final follow-up) was available for 87 patients. Good outcome (Nurick grade 0-3) at final follow-up was noted in 90% (45/50) of the patients with irreducible AAD/BI and 91.9% (34/37) of the patients with reducible AAD/BI. Preoperative poor Nurick grade (4-5) was the only factor associated with poor outcome. No significant difference in perioperative complications, outcome, and fusion was noted between patients who underwent TOO+PF or only PF for irreducible AAD/BI.
Many of the patients with congenital AAD/BI showed remarkable recovery after surgery. Preoperative poor Nurick grade (4-5) is associated with poor outcome. TOO+PF is a safe alternative treatment option for irreducible AAD/BI when only PF techniques are technically difficult/risky.
评估先天性颅颈交界区（CVJ）畸形伴寰枢椎脱位（AAD）/颅底凹陷症（BI）患者手术治疗的结果，并比较经口寰枢椎切除术联合后路融合术（TOO+PF）与单纯后路融合术（PF）治疗不可复位 AAD/BI 的疗效。
在 3 年的研究期间（2013 年 6 月至 2016 年 5 月），共纳入 94 例接受手术治疗的先天性 CVJ 畸形伴 AAD/BI 患者。其中，55 例患者存在不可复位 AAD/BI，其余 39 例患者存在可复位 AAD/BI。当考虑到术中寰枢关节关节面操作复位困难或风险较高时，仅对 34 例（36.2%）不可复位 AAD/BI 患者行 TOO+PF。其余不可复位 AAD/BI 患者及所有可复位 AAD/BI 患者（60/94；63.8%）仅行单纯后路融合术。术前诺里克分级较差、术前呼吸困难/颅神经功能障碍和脊髓空洞症与术后肺部并发症发生率显著升高相关。87 例患者获得≥3 个月的随访（最终随访）。最终随访时，不可复位 AAD/BI 患者中 90%（45/50）和可复位 AAD/BI 患者中 91.9%（34/37）的患者预后良好（诺里克分级 0-3 级）。术前诺里克分级较差（4-5 级）是预后不良的唯一相关因素。不可复位 AAD/BI 患者行 TOO+PF 或单纯 PF 的围手术期并发症、预后和融合率无显著差异。
许多先天性 AAD/BI 患者术后恢复显著。术前诺里克分级较差（4-5 级）与预后不良相关。当单纯后路融合技术操作困难/风险较高时，TOO+PF 是治疗不可复位 AAD/BI 的一种安全替代方法。
