A retrospective study.
Investigate the diagnosis and surgery strategy for treatment of development spinal canal stenosis (DSSA) at atlas plane based on CT image characters.
Summary of Background Data.
The occurrence of spinal canal stenosis in the atlas plane is relatively rare compared with lower cervical.
15 patients diagnosed with DSSA were included from 2014 to 2018. They are divided into 4 subgroups based on the character of CT images: group I (small size atlas), group II (hypertrophy of PAA), group III (incurved of PAA) and group IV (hypertrophy odontoid).
There are type I 7, type II 3 type III 2 and group IV 3 in the 15 cases. All the patients received different surgery procedures respectively: ①posterior arch osteotomy were performed for group I/III//IV without atlantoaxial dislocation, ② posterior arch resect and replantation were performed for group II ③ occipital cervical fixation and fusion were added to the patients with associated AAD. ④ a new method of odontoid reduce and atlantoaxial fixation by transoral approach were performed for group IV with associated AAD. All cases underwent surgery successfully which included OCF+PAR 8cases, PAR 4 cases, PAR R2 cases and DR+TARP 1 case without severe complications. All patients show different improvement in the symptoms. JOA scores improved from 9.2 to 14.7 in 1year follow-up.
DSSA could be easily diagnosed and divided into 4 subgroups according to the character of CT image, corresponding surgery strategy could receive a fine clinical result.
Level of Evidence: 4