Clinical Trial: Posterior Compression Distraction Reduction （CDR）Technique in the Treatment of BI-AAD

Study Status: Recruiting
Recruit Status: Recruiting
Study Type: Interventional

Official Title: Posterior Compression - Distraction Reduction (CDR) Technique in the Treatment of Basilar Invagination Associated With Atlantoaxial Dislocation

Brief Summary: Posterior compression - distraction reduction technique （CDR） in the treatment of Basilar invagination associated with atlantoaxial dislocation

Detailed Summary:

Basilar invagination (BI) refers to the skull base into the direction of cervical spine, mainly to the odontoid process into the foramen magnum is a major change of congenital cranial vertebral junction malformation. Different from trauma or inflammatory lesions, there exists not only in horizontal but also vertical direction dislocation between atlas and axis，At present there is no satisfactory and widely accepted operation method. At present, the main treatment strategy is adopt skull traction to patients preoperative or intraoperative and make vertebra X-ray observation. If the skull traction restored the atlanto-axial dislocation, This case belongs to restorable atlanto-axial dislocation. If the skull traction cannot restore the dislocation, that is non-restorable atlanto-axial dislocation. For the restorable type, posterior occipital cervical internal fixation and fusion should be performed. For the non restorable cases, the main theories is that various ligaments and scars is formed between the anterior arch of atlas and the odontoid process lead to the causes of the longitudinal traction, so transoral anterior atlanto-axial joint lysis is needed first, and then adopt posterior occipital-cervical internal fixation and interbody fusion after the atlanto-axial dislocation is restored. Because the anterior trans-oral atlanto-axial joint lysis has weakness of difficult and high risk, it has limit the popularization of the treatment of atlanto-axial dislocation. Currently only a few several spinal surgery centers have the ability to carry out. Another problem of this treatment strategy is that the function of posterior operation confined to occipital-cervical fixation in situ but not considered the try to adopt the posterior open reduction, this is mainly due to the current clinical application of occipital cervical posterior fixation system be lack of the pressure reduction effect.

  • Record the patients' cervical JOA score, ASIA score [ Time Frame: three days before surgery ]
    record the basic information of the patients before operation, to evaluate the
  • The first follow-up after surgery Record the patients' cervical JOA score, ASIA [ Time Frame: 3rd day post operation ]
    MRI.Performed imaging evaluation by radiology doctors.
  • ADI, CL and Cervicomedullary angle(CMA) by COP system and Compression Distraction Reduction， (CDR) [ Time Frame: 3rd day post operation ]
    ADI, CL and Cervicomedullary angle(CMA) calculations. All the patients perform posterior compression - distraction reduction, occipitocervical internal fixation and interbody fusion applied by COP system and Compression Distraction Reduction， (CDR)


    • Original Primary Outcome: Same as current

    Current Secondary Outcome: The second follow-up after operation Record the patients' cervical JOA score, ASIA score [ Time Frame: 6 months post operation ]

    Outpatient review at 6 months after surgery, adopt related neurological


    Original Secondary Outcome: Same as current

    Information By: Xuanwu Hospital, Beijing

    Dates:
    Date Received: June 1, 2015
    Date Started: July 2014
    Date Completion: June 2017
    Last Updated: June 1, 2015
    Last Verified: January 2015