• Xiangyang Ma, Xiaobao Zou, Zexing Chen, Haozhi Yang, Junlin Chen, Rencai Ma, Suochao Fu, and Hong Xia.
• Department of Orthopedics, General Hospital of Southern Theatre Command of PLA, Guangzhou, People's Republic of China.
• Spine. 2024 Aug 15; 49 (16): 111611241116-1124.

Study DesignRetrospective study.ObjectiveTo classify surgical failures following atlantoaxial dislocation, present strategies for revisions, and evaluate the clinical results of revision surgery.Summary Of Background DataWith the increase in atlantoaxial dislocation surgery, the number of surgical failures has gradually risen. However, current reports on atlantoaxial surgical revision are limited in scope. There remains a lack of summary regarding the causes of surgical failure, a detailed classification system, and no proposed strategy for revision surgery.Materials And MethodsA total of 109 cases of failed surgery following atlantoaxial dislocation were classified according to the reduction immediately after surgery and the fusion status before revision. The reduction, decompression, fusion status, and outcomes following revision surgery were evaluated by x-ray, computed tomography, magnetic resonance imaging, and the Japanese Orthopaedic Association score. The data were analyzed statistically with a paired-samples t test and multivariable logistic regression analysis.ResultsThe 109 patients were classified into three categories of failure: nonreduction with nonfusion (NR-NF, 73 cases), nonreduction with fusion (NR-F, 19 cases), and reduction with nonfusion (R-NF, 17 cases). Sixty-four patients underwent anterior revision, 21 posterior revision, and 24 anteroposterior revision. Postoperative complications were the primary cause of early revisions. After revision, complete decompression was achieved in all cases, anatomical reduction in 89 cases, significant improvement of Japanese Orthopaedic Association score in 77 cases, and fusion achieved in 86 cases. Twelve cases experienced surgical complications and three underwent a second revision.ConclusionsThe authors found that NR-NF was the most common type of failure following surgery for atlantoaxial dislocation. Revision strategies can be guided according to the descriptive classification of failure, and revision surgery should focus on achieving adequate reduction, appropriate fixation, and reliable fusion to optimize postsurgical outcomes.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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