Effectiveness of posterior reduction and fixation in atlantoaxial dislocation: a retrospective cohort study of 135 patients with a treatment algorithm proposal

  • Jian Guan
  • Zan Chen
  • Hao Wu
  • Qingyu Yao
  • Qu Wang
  • Can Zhang
  • Tengfei Qi
  • Kai Wang
  • Wanru Duan
  • Jun Gao
  • Yongning Li
  • Fengzeng JianEmail author
Original Article



Surgical procedures on atlantoaxial dislocation remain controversial. The aim of this observational retrospective study was to investigate the treatment algorithm of surgical procedures.


According to CT and intraoperative evaluation during direct posterior reduction, 135 AAD cases were categorized into three groups: Group I: reducible dislocation; Group II: irreducible dislocation (Group IIa: effective decompression achieved after posterior reduction; Group IIb: no effective decompression after posterior reduction); and Group III: fixed dislocation. Group III presented with extensive bony fusions. Group I and Group IIa were treated with direct posterior reduction and fixation. Group IIb underwent posterior fixation and transoral odontoidectomy. Group III underwent transoral odontoidectomy alone. Japanese Orthopedic Association scores (JOA) were assessed to evaluate clinical status before and 6, 12 months after surgery.


Our study included 118 Group I cases, 16 Group II cases (Group IIa: 11 cases; Group IIb: 5 cases), and one Group III case. Follow-up ranged from 12 to 36 months. Primary outcome: Anatomic atlantoaxial reduction was achieved in 118 of 135 patients (87.4%). Clinical improvements were seen in 96.3% (130/135) all the patients. Solid atlantoaxial fusion was shown in 134 patients. Secondary outcome: The overall complication rate was 3.7% (5/135). For Group I, the mean postoperative 6-month JOA was 14.5 versus 12.2 in preoperative patients (paired Student’s t test, P < 0.01).


This article proposes a clinical procedure that assists with therapeutic decision making and indicates the severity and difficulty of reduction of the atlantoaxial joint.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Atlantoaxial dislocation Categorization Posterior fusion Reduction Treatment strategy 



This research was funded by the innovative plan of Beijing Hospital Authority (Grant ID: PX2017002); general project of Beijing Natural Science Foundation (Grant ID: 7172091); Capital developmental innovation project of Beijing Municipal Commission of Health and Family Planning (Grant ID: SHOUFA-2018-2-2014).

Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Supplementary material

586_2018_5869_MOESM1_ESM.pptx (12.2 mb)
Supplementary material 1 (PPTX 12458 kb)


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Copyright information

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

Authors and Affiliations

  • Jian Guan
    • 1
  • Zan Chen
    • 1
  • Hao Wu
    • 1
  • Qingyu Yao
    • 1
  • Qu Wang
    • 3
  • Can Zhang
    • 1
  • Tengfei Qi
    • 1
  • Kai Wang
    • 1
  • Wanru Duan
    • 1
  • Jun Gao
    • 2
  • Yongning Li
    • 2
  • Fengzeng Jian
    • 1
    Email author
  1. 1.Department of Neurosurgery, Division of Spine, China International Neurological Institute, Xuanwu HospitalCapital Medical UniversityBeijingPeople’s Republic of China
  2. 2.Department of Neurosurgery, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople’s Republic of China
  3. 3.Department of NeurosurgeryThe People’s Hospital of Guizhou ProvinceGuiyangPeople’s Republic of China

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