A novel surgical management for pediatric patients with irreducible atlantoaxial dislocation: Transoral intraarticular cage distraction and fusion with C-JAWS staple ﬁxation

Frontiers in Surgery, 2023 · DOI: 10.3389/fsurg.2022.1054695 · Published: January 6, 2023

Simple Explanation

This study introduces a new surgical method for treating irreducible atlantoaxial dislocation (IAAD) in children. IAAD is a condition where the top two vertebrae in the neck are misaligned and cannot be easily corrected. The new method involves using a cage to distract the joint and C-JAWS staples for fixation, all done through the mouth. The traditional approach involves surgery from both the front and back of the neck, which can be more traumatic for children. This new technique aims to reduce surgical injuries by performing the entire procedure through a single transoral approach. The study followed eight pediatric patients who underwent this new surgical technique and analyzed their clinical data. The results showed satisfactory reduction, fixation, and bone fusion, suggesting that this technique is a safe and effective treatment option for pediatric IAAD.

Study Duration

3 years (June 2011 to June 2014)

Participants

8 pediatric patients with IAAD

Evidence Level

Not specified

Key Findings

1
The surgeries were successfully performed in all patients without injuries to spinal cord, nerve and blood vessel.
2
Clinical symptomatic relief was presented on all 8 patients (100%).
3
Satisfactory reduction was indicated by signiﬁcant decrease of atlanto-dental interval postoperatively (P < 0.05).

Research Summary

This study introduces a novel surgical technique for treating pediatric patients with irreducible atlantoaxial dislocation (IAAD) using a transoral approach involving intraarticular cage distraction and fusion with C-JAWS staple fixation. The study retrospectively analyzed the clinical data of eight pediatric patients who underwent this procedure, demonstrating satisfactory reduction, reliable fixation, and bone fusion without significant complications. The authors conclude that this technique is an effective and safe surgical option for treating IAAD in pediatric patients, offering a new method for anterior atlantoaxial fixation through a transoral approach.

Practical Implications

Reduced Surgical Trauma

The single transoral approach can minimize surgical injuries compared to traditional anteroposterior surgeries, especially beneficial for pediatric patients.

Effective Fixation

The C-JAWS staple provides reliable fixation for the atlantoaxial joint after intraarticular cage placement, promoting bone fusion and stability.

Improved Neurological Outcomes

The surgical technique leads to significant improvement in neurological function, as evidenced by increased JOA scores and spinal cord decompression.

Study Limitations

1
The sample size is ratter small.
2
this is a retrospective study.
3
Further prospective studies need to better control the follow-up intervals and require more standardized measurements.

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