Surgery for Chronic Traumatic Atlantoaxial Dislocation Associated With Myelopathy

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Cord Disorders

Background:

• Delayed myelopathy in atlantoaxial dislocation (AAD) is poorly understood.
• Optimal surgical timing and techniques for chronic AAD remain debated.

Purpose of the Study:

• To evaluate surgical outcomes for myelopathy secondary to atlantoaxial dislocation (AAD).
• To assess the efficacy of decompression and fusion in chronic AAD patients.

Main Methods:

• Retrospective study of 18 patients undergoing decompression, fixation, and fusion for AAD.
• Evaluation of demographic data, operative details, complications, and functional scores (JOA, VAS).
• Assessment of radiological parameters including fusion rate, space available for the cord, and compression indices.

Main Results:

• Surgical decompression and fusion led to improved neurological status in most patients.
• Significant improvements observed in Japanese Orthopedic Association scores and reduced visual analogue scale scores.
• High fusion rate (83%) and successful cord decompression (65.9%) achieved with favorable radiological changes.

Conclusions:

• Timely surgical intervention is critical to mitigate the risk of delayed myelopathy in AAD.
• Sufficient decompression and solid fusion are essential for chronic AAD, irrespective of complete reduction.
• Both C1-C2 and occipital-cervical fusion techniques yield satisfactory outcomes for reducible and irreducible AAD, respectively.