• Jianhua Wang, Haozhi Yang, Yuyue Chen, Guoqiang Liu, Ningling Xie, Shuang Zhang, and Guoqing Qiao.
• Department of Orthopedics, General Hospital of Southern Theatre Command, Guangzhou, China; Southern Medical University, Guangzhou, China. Electronic address: jianhuawangddrr@163.com.
• World Neurosurg. 2024 May 1; 185: e283e290e283-e290.

BackgroundTo evaluate the difficulty of reduction of congenital atlantoaxial dislocation with or without os odontoideum or basilar invagination based on computed tomography (CT) quantitative analysis.MethodsFrom March 2018 to December 2022, the CT features of 108 patients with atlantoaxial dislocation with or without os odontoideum or basilar invagination were analyzed. Quantitative scores were defined according to imaging features, including sloping of the lateral mass; osteophyte between the lateral mass joint; ball-and-socket deformity of the lateral mass joint; vertical interlocking of the lateral mass joint; callus between the lateral mass joint; and atlanto-odontoid joint hyperplasia, blocking, or fusion. Grades were calculated according to the sum of points of the atlanto-odontoid joint and lateral mass joints, as follows: I, 0-1 points; Ⅱ, 2-3 points; Ⅲ, 4-6 points; IV, 7-10 points. After 1 week of bidirectional cervical traction, CT scans were performed, and atlantodens interval and vertical distance from dens to Chamberlain line were measured. The vertical reduction rate, horizontal reduction rate, and overall reduction rate of atlantoaxial dislocation were calculated.ResultsThe vertical distance from dens to Chamberlain line values after traction were significantly reduced compared with before traction, including grades I, II, III, and IV. The overall reduction rates were 85.1% ± 11.8%, 65.8% ± 8.3%, 45.0% ± 8.5%, and 38.4% ± 13.0% respectively, after 1 week of bidirectional cervical traction.ConclusionsThe CT quantitative score system is an effective noninvasive evaluation to judge the reduction difficulty of atlantoaxial dislocation with or without os odontoideum or basilar invagination.Copyright © 2023. Published by Elsevier Inc.

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