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Congenital reducible atlantoaxial dislocation: classification and surgical considerations
S Behari1, V Bhargava, S Nayak
1Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India.
Acta Neurochirurgica
|November 16, 2002
Summary
Congenital reducible atlanto-axial dislocation (AAD) can cause severe neurological deficits. Surgical management and classification are key to improving patient outcomes and stabilizing neurological function.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Surgery
Background:
- Reducible atlanto-axial dislocation (AAD) poses risks of severe motor and respiratory compromise due to spinal cord/brain stem impingement.
- This study is the first to focus on the classification, surgical management protocols, and outcomes of congenital, reducible AAD.
Purpose of the Study:
- To classify congenital reducible AAD.
- To outline surgical management protocols.
- To evaluate the outcomes of surgical interventions for congenital reducible AAD.
Main Methods:
- 109 patients with congenital reducible AAD underwent posterior stabilization.
- Patients were preoperatively graded for disability (I-IV) and classified into 4 groups based on associated anomalies.
- Surgical procedures included various C1-C2 and occipitocervical fusion techniques.
Main Results:
- At follow-up, 64 of 86 patients showed improvement by at least one grade.
- 8 patients remained neurologically stable (Grade I), and 11 achieved stabilization of neurological functions.
- 3 patients experienced neurological deterioration despite successful radiological reduction and fusion.
Conclusions:
- Congenital reducible AAD patients can be classified into four groups based on surgical management.
- Hypermobile AAD associated with dysplastic odontoid requires specific precautions during intubation and positioning.
- An assimilated posterior arch can complicate surgical fixation due to joint synostosis.