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Related Experiment Video

Updated: Feb 13, 2026

Three and Four-Dimensional Visualization and Analysis Approaches to Study Vertebrate Axial Elongation and Segmentation
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[Rheumatoid atlanto-axial dislocation: a surgical approach].

I Yu Lisitskiy1, A M Kiselev1, S E Kiselev2

  • 1Vladimirsky Moscow Regional Research Clinical Institute. Shchepkina Str., 61/2, Moscow, Russia,129110.

Zhurnal Voprosy Neirokhirurgii Imeni N. N. Burdenko
|March 16, 2018
PubMed
Summary

Rheumatoid arthritis can cause atlanto-axial dislocation (AAD). Surgical treatment depends on deformity stability, with posterior approaches for mobile AAD and combined anterior/posterior approaches for fixed AAD.

Keywords:
atlanto-axial dislocationatlanto-axial fusioncraniovertebral regionoccipitocervical fusiontransoral approach

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Area of Science:

  • Neurosurgery
  • Rheumatology
  • Orthopedics

Background:

  • Pathological processes in the craniovertebral region (CVR) can cause dislocation and neurological deficits.
  • Rheumatoid arthritis is a common cause of atlanto-axial dislocation (AAD).
  • Diagnostic and treatment errors in rheumatoid disease can lead to adverse outcomes.

Purpose of the Study:

  • To define a surgical treatment approach for rheumatoid AAD in the CVR.
  • To account for deformity rigidity in surgical planning.

Main Methods:

  • Surgical treatment of five patients (4 female, 1 male; aged 54-73) with rheumatoid AAD.
  • Classification of dislocations as anterior, mobile (pannus-associated), or rigid (with odontoid invagination).
  • Surgical approaches included posterior-only for mobile AAD and combined anterior/posterior for rigid AAD.

Main Results:

  • Mobile AADs were treated with posterior decompression, dislocation correction, and atlanto-axial fusion, leading to brainstem decompression and anatomical restoration.
  • Spontaneous pannus resorption occurred post-surgery in mobile AAD cases.
  • Significant regression of pain and neurological deficits was observed in all patients; one case had wound infection.

Conclusions:

  • A decision algorithm for surgical treatment of rheumatoid AAD is based on deformity stability.
  • Mobile AADs are indicated for indirect decompression via posterior approach correction and fusion.
  • Fixed AADs necessitate posterior fixation combined with anterior decompression via a transoral approach.