To Investigate The Relationship Between The Change Of CMA And Clinical Efficacy And The Change Of Curvature Of Lower Cervical Spine After Atlantoaxial Dislocation

Objective:To investigate the relationship between the recovery of CMA and the changes of neurological function and curvature of lower cervical spine after atlantoaxial dislocation.Method:The clinical and imaging data of patients treated with AAD in our hospital from January 2013 to January 2016 were selected for retrospective analysis.Of the 46 patients,22 patients were incomplete or lost follow-up.Of the remaining 24 patients,13 were male and 11 were female,aged 17-65 years(42.5±9.7 years),and duration of disease was 3 months to 20 years(3.6 ± 4.2 years).The CMA of AAD patients was measured on the T2-weighted images of the cervical MRI before and after the final follow-up.The C2-7 Cobb angle was measured on the X-ray film of the cervical spine and the CMA and C2-7 Cobb angles were calculated.The JOA,VAS,and NDI scores were recorded before and at the end of the postoperative follow-up.The changes in JOA,VAS,and NDI scores were also calculated.Preoperative and final follow-up CMA,neurological function scores and related imaging parameters were compared using paired t test.Pearson correlation test was used to analyze the correlations between CMA and C2-7Cobb angles,JOA,VAS,and NDI before and after the final follow-up.Changes in CMA and changes in C2-7Cobb angles,JOA,VAS,and NDI scores were analyzed.The correlation between values.Results:Twenty-four patients completed the operation successfully,and the pedicle screws were well implanted during the operation.No postoperative spinal cord injury,no incision infection,and oropharyngeal infection.One case of vertebral artery injury was treated with careful intraoperative tamponade and hemostasis without causing major hemorrhage and cerebral ischemia.One case of pulmonary infection was cured after mechanical ventilation and anti-infective treatment.Neck pain in 1 case.Follow-up visits were no less than 24 months.X-ray,CT,and MRI were reviewed at 1 week postoperatively and at the final follow-up.The CM A increased from 120.05°±5.24° to 147.54°±5.76° preoperatively,and the C2-7 Cobb angle decreased from 18.8° ± 16.3° preoperatively to 12.7° ± 11.5°,with statistically significant differences(P<0.05)..At the final follow-up,all 24 patients had significantly improved JOA scores,NDI scores,and VAS scores before surgery.JOA scores increased from 8.75±2.31 preoperatively to 14.54± 1.96 at the final follow-up,and NDI scores were 27.25 preoperatively.The decrease of ±7.29 to 11.71 ±4.17 at the final follow-up,and the VAS score improved from 3.67 ± 1.58 preoperatively to 1.08±0.88 at the final follow-up visit.The differences were statistically significant.Pearson test analysis indicated that the change of CMA was positively correlated with the change of JOA score(r=0.621,P<0.05),negatively correlated with the change of NDI score(r=-0.564,P<0.05)and ?C1-The change in Cobb angle was negatively correlated(r=-0.526,P<0.05).There was no significant correlation with the change of VAS score(P>0.05).Conclusion:In patients with atlantoaxial dislocation,satisfactory results can be obtained by surgical treatment.Changes in CMA can directly reflect the compression of the spinal cord and the degree of postoperative decompression in patients with atlantoaxial dislocation and the recovery of nerve function and the curvature of the lower cervical spine in patients with atlantoaxial dislocation.Recovery is closely related to the prognosis of the atlantoaxial joint dislocation surgery is a good indicator.