Department of Orthopedics, Peking University Third Hospital, NO. 49 North Garden Road, Haidian District, Beijing, China.
Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China.
Eur Spine J. 2024 Jan;33(1):176-184. doi: 10.1007/s00586-023-07860-9. Epub 2023 Sep 2.
To present the clinical features and treatment strategy of degenerative atlantoaxial subluxation (DAAS).
Patients with DAAS treated in our institution from 2003 to 2020 were retrospectively reviewed. We utilized the Japanese Orthopedic Association (JOA) scale to evaluate the neurologic status and distance of Ranawat et al. (DOR) to measure vertical migration.
We recruited 40 patients with > 2 years of follow-up and an average age of 62.3 ± 7.7 years. All the patients had myelopathy; only one patient had moderate trauma before exacerbation of symptoms, and the duration of symptoms was 34 ± 36 months. The most frequent radiological features were vertical migration of C1 (100%), sclerosis (100%), and narrowing of the atlantoaxial lateral mass articulations (100%). Two patients underwent transoral release combined with posterior reduction and fusion, and 38 patients underwent posterior reduction and fusion with C1 lateral mass screws-C2 pedicle screws and plate systems only. Forty cases (100%) achieved a solid atlantoaxial fusion, and 38 cases (95%) achieved anatomic atlantoaxial reduction. The JOA score increased from 9.3 ± 2.6 to 14.8 ± 2.1 (P < 0.01). DOR increased from 14.5 ± 2.5 to 17.8 ± 2.2 mm at the final follow-up (P < 0.01). Loosening of the locking caps was detected in one case, bony fusion was achieved, and harvest-site pain was reported in five patients.
DAAS differs from other types of AAS and presents with anterior subluxation combined with vertical subluxation arising from degenerative changes in the atlantoaxial joints. We recommend anatomic reduction as an optimal strategy for DAAS.
介绍退行性寰枢关节半脱位（DAAS）的临床特征和治疗策略。
回顾性分析 2003 年至 2020 年在我院治疗的 DAAS 患者。采用日本骨科协会（JOA）评分评估神经功能状态，采用 Ranawat 等（DOR）距离评估垂直移位。
共纳入 40 例随访时间超过 2 年的患者，平均年龄为 62.3±7.7 岁。所有患者均有脊髓病；仅 1 例患者在症状加重前有中度创伤，症状持续时间为 34±36 个月。最常见的影像学特征是 C1 垂直移位（100%）、硬化（100%）和寰枢外侧关节狭窄（100%）。2 例患者接受经口松解联合后路复位融合，38 例患者仅接受后路复位融合，采用 C1 侧块螺钉-C2 椎弓根螺钉和钢板系统。40 例（100%）实现了寰枢关节牢固融合，38 例（95%）实现了寰枢关节解剖复位。JOA 评分从 9.3±2.6 提高到 14.8±2.1（P<0.01）。DOR 最终随访时从 14.5±2.5 增加到 17.8±2.2mm（P<0.01）。1 例发现锁定帽松动，骨质融合，5 例患者出现取骨部位疼痛。
DAAS 与其他类型的 AAS 不同，表现为前脱位合并由寰枢关节退行性改变引起的垂直脱位。我们建议解剖复位是治疗 DAAS 的最佳策略。
