Clinical Effect Of Atlantoaxial Pedicle Screw Fixation In The Treatment Of Atlantoaxial Instability

Objective To evaluate the clinical effect of atlantoaxial pedicle screw and lateral mass screw in the treatment of atlantoaxial instability,and to provide the basis for atlantoaxial pedicle screw in the treatment of atlantoaxial instability.Methods Participants included 45 cases of atlantoaxial instability,24 cases of atlantoaxial pedicle screw group and 21 cases of lateral mass screw group.The time of operation,the amount of bleeding,and the complications of vertebral artery,nerve root and spinal cord injury were recorded.The last follow-up,we used X-ray or CT to evaluate whether the screw was loose,displaced,and whether the bone graft was fused.We also used vas and JOA to evaluate the patients' pain and neurological improvement,and then evaluated the clinical effect of atlantoaxial pedicle screw technology in the treatment of atlantoaxial instability by statistical analysis.Results All the patients were operated smoothly,without serious injury of nerve,blood vessel and spinal cord.The incision was healed in one stage,without infection of incision.The patients in both groups were followed up effectively.The operative time and intraoperative blood loss in the atlantoaxial pedicle screw group were significantly better than those in the atlantoaxial lateral mass screw group(Table 2,P values were both less than 0.05).The average improvement rate of JOA was 76.4% and 68.7% respectively.There was no significant difference between the two groups of JOA(Table 2,P=0.92 >0.05).The visual analogue scale decreased from 5.46±2.02 to 1.58±1.89 in the pedicle screw group,and from4.57 ± 2.04 to an average of 0.76 ± 1.14 in the last follow-up in the lateral mass screw group.There was no significant difference in pain recovery between the two groups(Table 2,P=0.09>0.05).One patient in pedicle screw group had no significant improvement in neurological function after operation,which was related to the long history and irreversible changes of spinal cord function;Four patients in lateral mass screw group had venous plexus injury during operation,all of which stopped bleeding after treatment such as compression with gelatin sponge,and the lateral mass screw was successfully inserted,two of them received intraoperative blood transfusion;three patients in lateral mass screw group had occipitocervical pain after operation In the last follow-up,there was no significant difference.The X-ray and / or CT examination of cervical spine in the last follow-up showed that all patients had bone fusion,the screw position were satisfactory,no loosening or displacement.Conclusion Atlantoaxial pedicle screw technology does not need to expose the deep tissue of the lower edge of the posterior arch of atlas.It can reduce C2 nerve root injury and venous plexus hemorrhage,and has good stability,high fusion rate of bone graft.By relieving compression and reconstructing the stability of the upper cervical spine,the operation can significantly improve the patients' clinical symptoms,and improve the quality of life of patients.It is a safe and effective operation for atlantoaxial instability.