Authors: Markus Weißkopf Detlef Naeve Michael Ruf Jürgen Harms Dezsö Jeszenszky
Publish Date: 2004/07/16
Volume: 14, Issue: 1, Pages: 61-68
Abstract
Atlantoaxial rotatory dislocation AARD represents a rare pathological condition of the upper cervical spine that is frequently misdiagnosed leading to a delay in therapy In a longterm assessment of clinical and radiological results three different therapeutic options with regard to the length of the dislocationtherapy interval DTI were evaluated Twentysix patients were treated for AARD from December 1988 until April 2000 Proper diagnosis was established after an average interval of 15 months Three different therapeutical protocols were followed in order to reduce the dislocation 1 closed transoral reposition under general anesthesia 2 temporary transoral fixation utilizing the Harms Tplate 3 definitive transoral fusion The eight patients treated by closed reduction had the best pain relief The average visual analogue scale VAS score was 966 points while the rotatory motion of the upper cervical spine as assessed by dynamic MRI was 253° to each side The length of the dislocationtherapyinterval DTI averaged 14 months A mean VAS Score of 923 points was recorded in the ten patients treated with a temporary fixation of C1/C2 In this subgroup the DTI had an average length of 53 months The mean rotation to each side was 139° In the eight patients who underwent definitive fusion the mean VAS score was 606 points while the average length of the DTI was 405 months In conclusion the clinical outcome and the subjective wellbeing following AARD deteriorates with increasing length of the dislocationtherapy interval
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