Posterior Facet Distraction and Fusion Technique: Driving a Paradigm Shift in the Surgical Algorithm for Atlantoaxial...

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Atlantoaxial dislocation (AAD) presents significant surgical challenges at the craniovertebral junction.
• Traditional anterior-posterior approaches for AAD are associated with considerable morbidity.
• The posterior facet distraction and fusion (PFDF) technique offers a posterior-only alternative for AAD management.

Purpose of the Study:

• To evaluate the efficacy, outcomes, and safety of a PFDF-centered surgical strategy for AAD.
• To develop and validate a PFDF-based treatment algorithm for AAD.
• To compare PFDF outcomes with traditional surgical methods for AAD.

Main Methods:

• A retrospective study of 434 AAD patients treated with a PFDF-based algorithm from 2017-2024.
• Classification of patients into distractable or non-distractable groups based on preoperative imaging.
• Application of PFDF, combined approaches, or transoral odontoidectomy based on patient classification and surgical response.

Main Results:

• 91.9% of patients achieved satisfactory reduction and decompression with PFDF alone.
• Significant improvements in neurological and radiological outcomes were observed postoperatively (P < .001).
• High rates of anatomic reduction (90.9%) and complete bone fusion (100% within 12 months) were achieved with PFDF, alongside a low overall complication rate (5.1%).

Conclusions:

• The PFDF technique is a safe, effective, and standardized posterior approach for managing AAD.
• PFDF simplifies the AAD treatment algorithm, minimizing surgical morbidity and avoiding anterior surgery for most patients.
• High reduction and fusion rates achieved with PFDF highlight its clinical utility in AAD management.