Intraarticular bone grafting in atlantoaxial facet joints via a posterior approach: nonstructural or structural—a minimum 24-month follow-up

Journal of Orthopaedic Surgery and Research

Jian Wu¹  Huaijian Jin¹  Yufei Jin¹  Jun Zhu¹  Mingyong Liu¹  Keyu Luo¹  Zhong Wang¹  Yingbo Wang¹  Peng Liu² 

[1] Division of Spine Surgery, Department of Orthopedics, Daping Hospital of Army Medical University, 400042, Chongqing, China;Division of Spine Surgery, Department of Orthopedics, Daping Hospital of Army Medical University, 400042, Chongqing, China;State Key Laboratory of Trauma: Burns & Combined Wound, Institute for Traffic Medicine of Army Medical University, No. 10, Changjiangzhilu, Daping Street, Yuzhong District, 400042, Chongqing, China;

关键词: Bone grafting;    Fusion;    Atlantoaxial complex;    Facet joint;    Reduction;   

DOI  :  10.1186/s13018-021-02630-z

来源: Springer

【 摘 要 】

ObjectiveTo investigate the necessity of nonstructural or structural intraarticular bone grafting in atlantoaxial facet joints via a posterior approach and the influence by the presence of basilar invagination (BI).MethodsFrom November 2016 to October 2018, patients who underwent posterior atlantoaxial or occipitocervical arthrodesis surgery at one institute were retrospectively reviewed. Operation records, preoperative and postoperative clinical status, and radiological films were analyzed.ResultsThirty-three patients (19 without BI, 14 with BI) underwent posterior facet joint release followed by intraarticular bone grafting were enrolled finally. Twenty-four nonstructural (15 without BI, 9 with BI) and 9 structural (4 without BI, 5 with BI) grafting were performed. The average follow-up was 32.15±6.73 months (24–47 months). Among them, 1 (3.03%) implant failure occurred, and 32 (96.97%) achieved satisfactory neurological outcomes, including 28 (84.85%) complete and 4 (12.12%) acceptable reductions with complete fusion within 6 months. For patients without BI, structural and nonstructural grafting showed no significant difference in terms of reduction maintenance (100% vs 73.33%, p = 0.530), while for those with BI, structural grafting significantly increased the postoperative height of the joint space (5.67±1.22 mm vs 3.43±1.78 mm, p = 0.002) and maintained it much better than nonstructural grafting (88.89% vs 20.00%, p = 0.023), contributing notably to BI correction.ConclusionIntraarticular structural bone grafting in atlantoaxial facet joints has the advantage of maintaining anterior column height in the case of lateral mass collapse or when BI correction is needed; otherwise, nonstructural bone grafting is enough.

【 授权许可】

CC BY