| OBJECTIVE: To observe and compare the clinical effects of occipitocervical fusion and posterior atlanto-axial fusion in the treatment of atlanto-axial instability.Methods: A total of 47patients(17 females and 30 males;aged from 16 to 79 years;mean age 54.7 years)with atlantoaxial instability who underwent surgery between October 2012 to July 2016 were retrospectively analyzed.It was divided into group A(posterior atlantoaxial fusion,n=15)and group B(posterior atlanto-axial fusion,n=32)according to the different fixation segments.To assess the efficacy of surgery by comparing the JOA score improvement rate,cervical flexion,extension and rotational activity,cervical fusion rate.The difference of operative time,intraoperative bleeding volume,postoperative drainage volume for 3 days and hospitalization time was compared between the two groups,and the results were statistically analyzed.Results: All patients were completed operation successfully andwere followed up for 6 to 48 months(average time 21.4 months).There was no significant difference in JOA improvement rate,hospitalization time,postoperative drainage volume for 3 days and cervical fusion rate between the two groups(P>0.05).However,there were significant differences in the time of operation,intraoperative bleeding volume,postoperative cervical flexion and extension and rotation activity(P <0.05).The operation time and intraoperative blood loss in group B were less than those in group A,and had little effect on flexion,extension and rotational activity of cervical spine.Conclusion:Both occipitocervical fusion and posterior atlanto-axial fusion could obtain satisfactory therapeutic effect.However,comparedwithoccipitocervicalfusion,posterior atlanto-axial fusion has the advantages of less bleeding,shorter operation time,loss of cervical flexion and extension and rotation activity,and should be selected as the optimal choice for atlantoaxial instability surgery. |
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