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Reducibility-Based Posterior Reduction and Fusion Strategies for Atlantoaxial Dislocation: A Clinical and

Guipeng Zhao^1,2, Haotian Long^1,2, Dingyu Du^1,2

¹School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.

|May 7, 2026

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This study shows that tailoring posterior reduction and fusion for atlantoaxial dislocation (AAD) based on reducibility yields good outcomes. Direct reduction is preferred for reducible AAD, while distraction and cage implantation benefit irreducible cases.

Area of Science:

Neurosurgery
Orthopedic Surgery
Spinal Surgery

Background:

Atlantoaxial dislocation (AAD) presents complex surgical challenges.
Determining optimal surgical strategies based on reducibility is crucial for effective management.

Purpose of the Study:

To evaluate clinical and radiological outcomes of posterior reduction and fusion for AAD.
To compare strategies with and without interfacet joint distraction and cage implantation based on reducibility.

Main Methods:

Retrospective analysis of 90 AAD patients categorized by reducibility.
Surgical management involved posterior reduction and fusion, with or without interfacet joint distraction and cage implantation.
Clinical outcomes (JOA, VAS, satisfaction) and radiological parameters (atlanto-dental interval, DOCL, CXA, OAAF) were assessed.

Keywords:

Atlantoaxial joint Internal fixators Joint dislocations Neurosurgical procedures Spinal fusion Surgery

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Main Results:

All patients showed significant improvements in JOA and VAS scores.
The irreducible group had smaller preoperative CXA and greater OAAF, with OAAF > 32.4° predicting reducibility.
Postoperative changes in DOCL and CXA were more pronounced in the irreducible group.
Fusion rates were high and comparable between groups (92.6% vs. 94.4%).

Conclusions:

A reducibility-based posterior reduction fusion strategy provides satisfactory outcomes for AAD.
Direct reduction is suitable for reducible AAD, while interfacet joint distraction and cage implantation are vital for irreducible AAD.
Preoperative OAAF is a potential predictor of AAD reducibility.