Which radiologic parameters affect clinical outcomes after C1-2 posterior fusion for atlantoaxial dislocation?
EANS Academy. Park J. 09/25/19; 275734; EP02122
Assoc. Prof. Jong-Hyeok Park
Assoc. Prof. Jong-Hyeok Park

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Abstract
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Purpose: To evaluate which radiologic parameters affect the clinical outcomes in patients underwent C1-2 fusion for atlantoaxial dislocation.
Methods: From January 2014 to December 2017, 98 patients underwent C1-2 posterior fusion was included. Patients with previous cervical surgery or basilar invagination were excluded. Surgeries extended to occipital or subaxial level (laminoplasty/laminectomy) were also excluded. Finally, 38 patients were included in this study. C1-7, C1-2, C2-7 cobbs angle (CA), and T1 slope were measured on standard cervical radiograph preoperatively and at final follow-up. C1-7, C2-7 sagittal vertical axis (SVA), and posterior atlantodental interval (pADI) were also measured. Subaxial kyphosis was defined to decrease 10° at C2-7 angle after surgery. Neck VAS, JOA score and NDI were used to evaluate the clinical outcomes.
Results: Mean age was 54.4±15.9. Male to female ratio was 14 to 24. Mean BMI was 23.3±3.6. Of radiologic parameters, the C1-7, C1-2, C2-7 cobbs angle, and T1 slope were changed from 34.9°±11.1°, 18.0°±11.2°, 16.9°±10.3°, 19.9°±8.7° to 33.4°±12.0°, 19.5°±6.2°, 14.0°±10.2°, 19.2°±7.2° at final follow-up. The C1-7, C2-7 SVA, and pADI were changed from 26.4±12.9mm, 11.8±12.1mm, 17.1±3.3mm to 22.57±13.0mm, 14.4±10.6mm, 21.6±3.4mm. The incidence of postoperative subaxial kyphosis was 23.7% at final follow-up. There was no significant correlation between postoperative subaxial kyphosis and VAS, JOA score, NDI. Neck VAS correlates with △C1-7 cobbs angle (p< 0.05). JOA score also correlates with △C1-7 SVA (p< 0.05). Furthermore, postoperative subaxial kyphosis in patients less than 17mm in C1-7 SVA represented poor clinical outcomes.
Conclusions: Postoperative subaxial kyphosis was not associated with the clinical outcomes statistically. △C1-7 cobbs angle and △C1-7 SVA showed the relationship with the clinical outcomes.
Purpose: To evaluate which radiologic parameters affect the clinical outcomes in patients underwent C1-2 fusion for atlantoaxial dislocation.
Methods: From January 2014 to December 2017, 98 patients underwent C1-2 posterior fusion was included. Patients with previous cervical surgery or basilar invagination were excluded. Surgeries extended to occipital or subaxial level (laminoplasty/laminectomy) were also excluded. Finally, 38 patients were included in this study. C1-7, C1-2, C2-7 cobbs angle (CA), and T1 slope were measured on standard cervical radiograph preoperatively and at final follow-up. C1-7, C2-7 sagittal vertical axis (SVA), and posterior atlantodental interval (pADI) were also measured. Subaxial kyphosis was defined to decrease 10° at C2-7 angle after surgery. Neck VAS, JOA score and NDI were used to evaluate the clinical outcomes.
Results: Mean age was 54.4±15.9. Male to female ratio was 14 to 24. Mean BMI was 23.3±3.6. Of radiologic parameters, the C1-7, C1-2, C2-7 cobbs angle, and T1 slope were changed from 34.9°±11.1°, 18.0°±11.2°, 16.9°±10.3°, 19.9°±8.7° to 33.4°±12.0°, 19.5°±6.2°, 14.0°±10.2°, 19.2°±7.2° at final follow-up. The C1-7, C2-7 SVA, and pADI were changed from 26.4±12.9mm, 11.8±12.1mm, 17.1±3.3mm to 22.57±13.0mm, 14.4±10.6mm, 21.6±3.4mm. The incidence of postoperative subaxial kyphosis was 23.7% at final follow-up. There was no significant correlation between postoperative subaxial kyphosis and VAS, JOA score, NDI. Neck VAS correlates with △C1-7 cobbs angle (p< 0.05). JOA score also correlates with △C1-7 SVA (p< 0.05). Furthermore, postoperative subaxial kyphosis in patients less than 17mm in C1-7 SVA represented poor clinical outcomes.
Conclusions: Postoperative subaxial kyphosis was not associated with the clinical outcomes statistically. △C1-7 cobbs angle and △C1-7 SVA showed the relationship with the clinical outcomes.
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