Wu Ji, Li Yang, Chu Wenxiang, Chen Fei, Xu Zhenji, Ding Yiyang, Ni Bin, Lu Xuhua, Guo Qunfeng
Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai , People's Republic of China.
Oper Neurosurg. 2025 May 1;28(5):627-633. doi: 10.1227/ons.0000000000001347. Epub 2024 Aug 29.
For irreducible atlantoaxial rotary fixation (AARF), anterior or posterior release was often needed before posterior reduction and fusion. Anterior atlantoaxial joint release has potential complications such as retropharyngeal abscess, persistent hoarseness, and infection. This study aims to assess the efficacy of posterior release, reduction, and intra-articular fusion without resecting the C2 nerve root on irreducible type III AARF.
The data of 9 pediatric patients diagnosed with AARF who underwent posterior atlantoaxial release, reduction, and intra-articular fusion without resecting the C2 nerve root were retrospectively reviewed. Japanese Orthopaedic Association scores and Visual Analog Scale for Neck Pain were used to assess outcomes. The preoperative and follow-up assessments of atlantodens interval (ADI) were documented to evaluate the reduction of atlantoaxial joint. The patient demographics, surgery time, blood loss, bone fusion time, follow-up period, and surgery-related complications were meticulously documented.
The mean follow-up duration was 35.1 ± 11.5 months. Complete reduction was achieved in 8 patients, while one patient did not achieve complete reduction. The ADI decreased significantly from 8.7 ± 2.2 mm before surgery to 2.1 ± 1.3 mm at the final follow-up. All patients demonstrated successful bone fusion, with an average fusion period of 3.7 ± 1.3 months. The Visual Analog Scale for Neck Pain at the final follow-up exhibited a significant decrease compared with preoperative values ( P < .05), while no significant difference was observed in Japanese Orthopaedic Association scores. There were no complications related to surgery.
Posterior atlantoaxial release, reduction, and intra-articular fusion with a C2 nerve root preservation technique is effective in the treatment of irreducible type III AARF.
对于不可复位的寰枢椎旋转固定（AARF），在进行后路复位和融合之前，通常需要进行前路或后路松解。寰枢椎前路关节松解存在潜在并发症，如咽后脓肿、持续性声音嘶哑和感染。本研究旨在评估在不切除C2神经根的情况下，后路松解、复位及关节内融合治疗不可复位的III型AARF的疗效。
回顾性分析9例诊断为AARF并接受后路寰枢椎松解、复位及关节内融合且未切除C2神经根的儿科患者的数据。采用日本骨科协会评分和颈部疼痛视觉模拟量表评估疗效。记录术前和随访时的寰齿间距（ADI），以评估寰枢椎关节的复位情况。详细记录患者的人口统计学资料、手术时间、失血量、骨融合时间、随访时间及手术相关并发症。
平均随访时间为35.1±11.5个月。8例患者实现了完全复位，1例患者未实现完全复位。ADI从术前的8.7±2.2mm显著降至末次随访时的2.1±1.3mm。所有患者均成功实现骨融合，平均融合时间为3.7±1.3个月。末次随访时颈部疼痛视觉模拟量表较术前显著降低（P<.05），而日本骨科协会评分无显著差异。无手术相关并发症。
采用保留C2神经根技术的后路寰枢椎松解、复位及关节内融合治疗不可复位的III型AARF是有效的。
