One-Stage Anterior Retropharyngeal Release Followed by Posterior Open Reduction and Intra-Articular Cage Fusion for Treating Chronic Fixed Type III Atlantoaxial Rotatory Fixation.

Objective: To verify the effectiveness of anterior retropharyngeal release followed by posterior open reduction using long arm reduction screws combined with intra-articular fusion with a cage filled with the local autologous bone for treating fixed Type III atlantoaxial rotatory fixation (AARF).

Methods: Data from 6 children with fixed AARF were retrospectively reviewed. All patients underwent anterior retropharyngeal release followed by posterior open reduction using long-arm reduction screws combined with intra-articular fusion with a cage filled with local autologous bone. Outcomes were measured using the atlantodental interval value, the Japanese Orthopedic Association score and visual analog scale for neck pain. Patient age, sex, operation time, blood loss, and bone fusion time were recorded. Complications related to the operation were also recorded.

Results: All patients achieved complete reduction and solid bone fusion at follow-up. The atlantodental interval dropped to 2.1 ± 0.5 mm after the operation from a preoperative score of 15.3 ± 3.1 mm (P < 0.05). Japanese Orthopedic Association score significantly improved from a preoperative score of 15.3 ± 0.5 to 17 ± 0 at the final follow-up (P < 0.05). Visual analog scale for neck pain markedly decreased from preoperative 4.5 ± 1.0 to 0.2 ± 0.4 at the final follow-up (P < 0.05). No complication related to the surgical approach or instrumentation was observed.

Conclusions: One-stage anterior retropharyngeal release followed by posterior open reduction combined with intra-articular cage fusion is effective in treating chronic fixed type III AARF.