• Jia Shao, Yan Zheng Gao, Kun Gao, and Zheng Hong Yu.
• Department of Spinal Surgery, Henan Provincial People's Hospital, Henan, China.
• World Neurosurg. 2019 Dec 1; 132: e193-e201.

ObjectiveTo evaluate the effect of screw-rod fixation and selective axial loosening in the treatment of atlantoaxial instability or dislocation (including reducible and irreducible) caused by os odontoideum (OO) via a single posterior approach.MethodsA consecutive series of patients with OO surgically treated in our hospital were retrospectively analyzed. For atlantoaxial instability and reducible atlantoaxial dislocation, C1-C2 screw-rod fixation and fusion were performed. OO combined with irreducible atlantoaxial dislocation was reduced after posterior axial loosening, followed by screw-rod fixation and fusion. The general information, clinical data, and radiographic data were compared between the 2 different procedures.ResultsThere were 41 patients with an average age of 40.6 ± 21.7 years. All the patients underwent posterior reduction and C1-2 screw rod fixation, 6 with axial loosening and 35 without axial loosening. The clinical manifestations and radiographic data significantly improved after the operation with a low rate of complications. Except for clivus-canal angle and visual analogue score of cervical pain, there were no differences in clinical and radiographic data between the 2 procedures.ConclusionsPosterior screws-rod fixation and selective axial loosening is appropriate for treating OO complicated with atlantoaxial instability or dislocation (including reducible and irreducible) without the need for anterior decompression.Copyright © 2019 Elsevier Inc. All rights reserved.

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