Surgical Strategy and Decision Making in Recurrent Atlanto-Axial Dislocations: The Role of Traction.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY Accounts of Chemical Research Pub Date : 2024-10-30 DOI:10.1016/j.wneu.2024.10.099

Kavin K Devani, Souvik Singha, Pulkit Purohit, Nupur Pruthi

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Abstract

Objective: To analyse patients with recurrent atlantoaxial dislocation and give a criterion of an ideal patient who can benefit from redo surgery.

Methods: This retrospective study was conducted in a tertiary care centre, which included 20 patients who failed atlantoaxial surgery from January 2013 to June December 2021. They were evaluated using X-ray, CT, and MRI examinations, and their clinical data were accessed from the hospital's medical records department and the picture archiving and communication system. They were given a trial of traction to look for clinical and/or radiological improvement. Those showing clinical and/or radiological improvement underwent redo fixation. The operative steps involved removing joint capsules, denuding articular cartilage and joint preparation followed by reduction of basilar invagination by the combination of spacer and/or bone graft and putting screws in C1/Occiput and C2. A strut graft was placed between Occiput/ C1 and C2.

Results: The mean change in mJOAS and Nurick grade following the first surgery was statistically significant (1.00 ± 0.73, p-value 0.002 and -0.15 ± 0.27, p-value 0.046, respectively). On similar paths, the mean change in mJOAS and Nurick grade following the second surgery was also statistically significant (4.25 ± 0.32, p-value <0.001 and -1.2 ± 0.11, p-value <0.001, respectively). Improper usage of constructs (31.57%), inadequate/no joint preparation (42.10%/57.90%) and poor choice of graft (100%) were the leading causes of failure of index surgery.

Conclusions: The best candidates who can benefit after re-do surgery are the ones who exhibit either clinical and/or radiological improvement on the trial of traction, as the pathological C1-C2 joints are either not fused or have undergone pseudoarthrosis. Those patients who do not exhibit significant clinical or radiological improvement post-trial of traction should not be offered subsequent surgical intervention.

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复发性寰枢椎脱位的手术策略和决策：牵引的作用

目的分析复发性寰枢关节脱位患者，并给出能够从重做手术中获益的理想患者的标准：这项回顾性研究在一家三级医疗中心进行，纳入了 2013 年 1 月至 2021 年 6 月期间寰枢椎手术失败的 20 名患者。他们通过X光、CT和磁共振成像检查进行了评估，并从医院的病历部门和图片存档与通信系统中获取了他们的临床数据。对他们进行牵引试验，以观察临床和/或放射学方面的改善情况。临床和/或放射学情况有所改善的患者接受了重新固定手术。手术步骤包括去除关节囊、剥离关节软骨和关节准备，然后通过垫片和/或植骨减少基底内陷，并在C1/Occiput和C2植入螺钉。结果：第一次手术后，mJOAS 和 Nurick 分级的平均变化具有统计学意义（分别为 1.00 ± 0.73，p 值 0.002 和 -0.15 ± 0.27，p 值 0.046）。在相似的路径上，第二次手术后 mJOAS 和 Nurick 分级的平均变化也具有统计学意义（4.25 ± 0.32，P 值结论：由于病变的C1-C2关节要么未融合，要么已发生假关节化，因此在牵引试验中表现出临床和/或放射学改善的患者是再次手术后的最佳受益者。那些在牵引试验后临床或放射学症状没有明显改善的患者不应接受后续手术治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.

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