A modified microsurgical interfacet release and direct distraction technique for management of congenital atlantoaxial dislocation: technical note

  • GuoSong Shang
  • Tao FanEmail author
  • Zhe Hou
  • Cong Liang
  • YinQian Wang
  • XinGang Zhao
  • Wayne Fan
Technical Note


Various techniques have been used for management of congenital atlantoaxial dislocation. Recently, the reduction of atlantoaxial dislocation through a single posterior approach has attracted more and more attention. Here, we present a modified technique including direct interfacet release and distraction between C1 and C2 by a specially designed distractor, posterior internal fixation and bone graft fusion. The illustrated technique was performed in 15 consecutive patients, and the outcomes were recorded and analyzed. Follow-up ranged from 12 to 26 months. Clinical symptoms improved in 14 patients (93.3%) and were stable in 1 patient (6.7%). Radiologically, 60–100% reduction was achieved in 13 patients (86.6%). Bone fusion was obtained in all patients at 12 months after the operation. The two-tailed Wilcoxon signed-rank test was used to analyze the preoperative and postoperative Japanese Orthopedic Association scores (JOA), atlas-dens interval (ADI), and cervicomedullary angle (CMA) (P < 0.001). Our results suggested that this direct interfacet release and distraction technique with a specially designed C1–2 distractor can provide a definite effective C1–2 facet distraction and odontoid process restoration through a single posterior approach.


Atlantoaxial dislocation Odontoid process Interfacet distraction 


Financial support

This study was funded by the Construction Project of National Clinical Key Specialties of People’s Republic of China [Ministry of Health of People’s Republic of China 873 (2011)] and the Capital Health Research and Development of Special 2014-2-8011. The corresponding author, Tao Fan, received the support of these funding sources.

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. This article does not contain any studies with human participants performed by any of the authors.

Conflict of interest

The authors declare that they have no conflicts of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Neurosurgery, Linfen People’s HospitalShanxi Medical UniversityLinfenPeople’s Republic of China
  2. 2.Spine Center, Sanbo Brain HospitalCapital Medical UniversityHaidian DistrictPeople’s Republic of China
  3. 3.Department of Neurosurgery, Beijing Luhe HospitalCapital Medical UniversityTongzhou DistrictPeople’s Republic of China
  4. 4.Faculty of ScienceUniversity of British ColumbiaVancouverCanada

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