Influence of the type of atlantoaxial dislocation secondary to os odontoideum on sagittal alignment and balance of the subaxial cervical spine after posterior atlantoaxial fusion

This retrospective study aims to investigate the effect of the type of atlantoaxial dislocation due to os odontoideum on the sagittal alignment and balance of the cervical spine after posterior atlantoaxial fusion.

Data of 48 consecutive patients who underwent posterior C1–C2 fusion to treat atlantoaxial dislocation/instability due to os odontoideum were retrospectively reviewed. Radiographic variables, namely the T1 slope (T1S), C1–C2 angle, C2–C7 angle, C1–C2 sagittal vertical axis (SVA), C2–C7 SVA, and modified atlas–dens interval (MADI), were measured preoperatively, immediate postoperatively, and at final follow-up. Patients were divided into three groups based on the preoperative MADI. Differences within and between groups in radiographic variables and relationships between the investigated variables were analyzed.

The MADI was correlated with the preoperative to postoperative changes in the C1–C2 angle (r = 0.776, P < 0.05) and C2–C7 angle (r = − 0.357, P < 0.05). In the group with anterior atlantoaxial dislocation, the C1–C2 angle and C2–C7 SVA were significantly enlarged at final follow-up (P < 0.05), while the C2–C7 angle was significantly reduced (P < 0.05). The changes in C1–C2 angle and C2–C7 angle were opposite between the posterior group and the anterior dislocation group.

The direction/type of atlantoaxial subluxation correlates with the changes in lower cervical curvature after atlantoaxial fusion. Patients with atlantoaxial posterior dislocation and atlantoaxial instability are less likely than those with atlantoaxial anterior dislocation to develop loss of lordosis after posterior atlantoaxial fusion.