Sheng Xia-Qing, Peng Zi-Han, Pan Nan-Fang, Zhao You-Jin, Gong Quan, Song Yue-Ming, Gong Qi-Yong, Liu Hao, Meng Yang
Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.
Eur Spine J. 2025 Jan;34(1):69-77. doi: 10.1007/s00586-024-08498-x. Epub 2024 Sep 19.
The type of atlantodental space tissue in patients with atlantoaxial dislocation (AAD) can help doctors understand the possibility of reduction before surgery. However, relevant research on this topic is lacking. In this study, we aimed to summarise the atlantodental space classification of patients with AAD using magnetic resonance imaging (MRI) and explore their clinical characteristics.
Preoperative 3T cervical MR images of patients who underwent posterior reduction and fixation surgery for non-traumatic AAD between 1 September 2012 and 31 July 2023 were collected. Two radiologists read and recorded the MRI results based on the standard protocol. The kappa value was used to evaluate intra- and inter-observer agreements. The patient's age, sex, body mass index, clinical symptoms, Japanese Orthopaedic Association (JOA) score, and visual analogue scale information were obtained from medical records.
A total of 135 patients with AAD (mean age, 51.3 ± 14.0 years, 52 men) were included in the analysis. The inter-observer agreement between the two readers was 0.818 (P < 0.0001). The intra-observer consistencies were 0.882 (P < 0.0001) and 0.896 (P < 0.0001). Patients with inflexible tissue signs exhibit more irreducible in hyperextension position, and their range of motion of ADI is smaller. These patients were older and had a higher incidence of abnormal spinal cord signals and JOA scores.
Novel MRI signs exhibited high inter- and intra-observer consistency and were associated with patient age, abnormal spinal cord signals, reducibility, range of motion of ADI, and symptoms.
寰枢椎脱位（AAD）患者寰齿间隙组织类型有助于医生了解手术前复位的可能性。然而，关于该主题的相关研究较少。本研究旨在总结采用磁共振成像（MRI）对AAD患者进行的寰齿间隙分类，并探讨其临床特征。
收集2012年9月1日至2023年7月31日期间因非创伤性AAD接受后路复位固定手术患者的术前3T颈椎MR图像。两名放射科医生根据标准方案读取并记录MRI结果。kappa值用于评估观察者内和观察者间的一致性。从病历中获取患者的年龄、性别、体重指数、临床症状、日本骨科协会（JOA）评分和视觉模拟量表信息。
共纳入135例AAD患者（平均年龄51.3±14.0岁，男性52例）进行分析。两名读者之间的观察者间一致性为0.818（P<0.0001）。观察者内一致性分别为0.882（P<0.0001）和0.896（P<0.0001）。组织僵硬体征患者在过伸位时更难复位，其寰齿间距（ADI）活动范围较小。这些患者年龄较大，脊髓信号异常发生率和JOA评分较高。
新的MRI征象在观察者间和观察者内均表现出较高的一致性，且与患者年龄、脊髓信号异常、可复性、ADI活动范围及症状相关。
