Single stage anterior release and posterior instrumented fusion for irreducible XXXX with @entity3473 .

@entity1 @entity602 @entity3029 @entity3473 @entity9807 @entity37397
BACKGROUND CONTEXT: The options available for treatment of Irreducible @entity3029 (IAAD) with @entity3473 are odontoidectomy, posterior decompression, @entity9807 . In 2006 Wang et al described that most IAAD can be reduced following anterior release of contracted soft tissues. Anterior release may be done by transoral (TO) or @entity37397 ( @entity37397 ) approach. Posterior instrumented fusion provides stability and helps in achieving further reduction. PURPOSE: To study the neurological and radiological outcome following treatment of @entity3473 associated with irreducible @entity3029 (IAAD) by anterior release and posterior instrumented fusion. STUDY DESIGN: Retrospective Case Series @entity1 SAMPLE: 19 OUTCOME MEASURE: @entity1 were assessed for neurologic recovery by Benzel's modified Japanese Orthopaedic Association (mJOA) score and radiologically by assessing reduction on lateral radiographs and comparing clivus-canal angle on pre-op _ post-op CT scan. METHODS: 19 consecutive @entity1 with IAAD were surgically treated. Anterior release was done via TO approach in 12 @entity1 and @entity37397 approach in 7. Following anterior release all @entity1 underwent posterior instrumented fusion. RESULTS: Study included 15 males and 4 females with mean follow-up of 18 months. Pathology included occipitalisation of atlas in 16 @entity1 , os odontoideum in 2 and missing posterior elements of axis in 1. All @entity1 had cervical @entity602 . Occipitocervical fixation was done in 18 @entity1 and C1-2 trans-articular screw fixation in one. 15 @entity1 had anatomic reduction while 4 had partial. The clivus-canal angle improved from a mean pre-op angle of 111.47(0) to mean post op angle of 142.84(0). The mJOA improved from pre-op mean mJOA of 12.89 to a post-op mean mJOA of 16.84. Fusion was achieved in all @entity1 . Maceration of posterior wound was noted in 3 @entity1 which healed by daily cleaning and dressing (C _ D). Implant breakage on one side was noted in one @entity1 at 3 months post op, however @entity1 remained asymptomatic. CONCLUSION: This series reinforces the safety and efficacy of both trans-oral and retro-pharyngeal anterior release for reduction of Irreducible AAD. Posterior fixation helps in achieving further reduction and provides stability. Anterior release followed by instrumented posterior fusion is a safe and effective modality of treatment for irreducible AAD associated with @entity3473 .
