Although transoral atlantoaxial reduction plate (TARP) surgery has been confirmed to be safe and effective for adults who have irreducible atlantoaxial dislocation (IAAD) with or without basilar invagination or upper cervical revision surgery, it is rarely used to treat these disorders in children. The authors of this study aimed to report on the use of the anterior technique in treating pediatric IAAD.
In this retrospective study, the authors identified 8 consecutive patients with IAAD who had undergone surgical reduction at a single institution in the period between January 2011 and June 2104. The patients consisted of 5 males and 3 females. Three had os odontoideum, 2 had basilar invagination, and the other 3 experienced atlantoaxial rotatory fixed dislocation (AARFD). They were all treated using transoral anterior release, reduction, and fusion with the TARP. Preoperative and postoperative CT scans and MR images were obtained. American Spinal Injury Association (ASIA) Impairment Scale grades were determined.
All symptoms were relieved in all 8 patients but to varying degrees. Intraoperative loose reduction and fixation of C1–2 were achieved in one stage. The 4 patients with preoperative neurological deficits were significantly improved after surgery, and their latest follow-ups indicated that their ASIA Impairment Scale grades had improved to E. Postoperative pneumonia occurred in 1 patient but was under complete control after anti-infective therapy and fiber optic–guided sputum suction.
One-stage transoral anterior release, reduction, and fixation is an effective, reliable, and safe means of treating pediatric IAAD. The midterm clinical results are satisfactory, with the technique eliminating the need for interval traction and/or second-stage posterior instrumentation and fusion.
ABBREVIATIONSAAD = atlantoaxial dislocation; AARFD = atlantoaxial rotatory fixed dislocation; ADI = atlantodental interval; ASIA = American Spinal Injury Association; IAAD = irreducible AAD; TARP = transoral atlantoaxial reduction plate.
Correspondence Hong Xia: Southern Theater General Hospital of People’s Liberation Army, Guangzhou, China. firstname.lastname@example.org.INCLUDE WHEN CITING Published online June 14, 2019; DOI: 10.3171/2019.4.PEDS1928.
C.Z. and and J.W. contributed equally to this work and share first authorship.
Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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