Independent correlation of the C1–2 cobb angle with patient-reported outcomes after correcting chronic atlantoaxial instability

Zhimin Pan, Yanhai Xi, Wei Huang, Keung Nyun Kim, Seong Yi, Dong Ah Shin, Kai Huang, Yu Chen, Zhongren Huang, Da He, Yoon Ha

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Objective: To investigate three-planar radiographic results and patient-reported outcomes (PROs) after correcting chronic atlantoaxial instability (AAI) by translaminar screw (TLS) and pedicle screw (PS) fixation, and to explore the potential association of atlantoaxial realignment with PRO improvements. Methods: Twenty-three patients who underwent C1 lateral mass screw (LMS)-C2 TLS and 29 who underwent C1 LMS-C2 PS with ≥ 2 years of follow-up were retrospectively analyzed. Three-planar (sagittal, coronal, and axial) radiographic parameters were measured. PROs including the Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) score and the Short Form 36 Physical Component Summary (SF-36 PCS) were documented. Factors potentially associated with PROs were identified. Results: The radiographic parameters significantly changed postoperatively except the C1–2 midlines’ intersection angle in the TLS group (p = 0. 073) and posterior atlanto-dens interval in both groups (p = 0. 283, p = 0. 271, respectively). The difference in bilateral odontoid lateral mass interspaces at last follow-up was better corrected in the TLS group than in the PS group (p = 0. 010). Postoperative PROs had significantly improved in both groups (all p < 0. 05). Thereinto, NDI at last follow-up was significantly lower in the TLS group compared with PS group (p = 0. 013). In addition, blood loss and operative time were obviously lesser in TLS group compared with PS group (p = 0.010, p = 0.004, respectively). Multivari-able regression analysis revealed that a change in C1–2 Cobb angle was independently correlated to PROs improvement (NDI: β =-0. 435, p = 0. 003; JOA score: β = 0. 111, p = 0. 033; SF-36 PCS: β = 1. 013, p = 0. 024, respectively), also age ≤ 40 years was independently associated with NDI (β = 5. 40, p = 0. 002). Conclusion: Three-planar AAI should be reconstructed by C1 LMS-C2 PS fixation, while sagittal or coronal AAI could be corrected by C1 LMS-C2 TLS fixation. PROs may improve after atlantoaxial reconstruction in patients with chronic AAI. The C1–2 Cobb angle is an independent predictor of PROs after correcting chronic AAI, as is age ≤ 40 years for postoperative NDI.

Original languageEnglish
Pages (from-to)267-276
Number of pages10
Issue number2
Publication statusPublished - 2019 Jun

Bibliographical note

Funding Information:
This study was financially supported by the grants of China Scholarship Council (2017-3109/201708260068) and 5511 Innovation-driven Program of Jiangxi Province Department of Science and Technology (20165BCB18017). We thank Sun Kyu Choi (Yonsei University College of Medicine) and Huiyong Hu (Children’s Hospital of Shanghai) for their statistical suggestions.

Publisher Copyright:
© 2019 by the Korean Spinal Neurosurgery Society.

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology


Dive into the research topics of 'Independent correlation of the C1–2 cobb angle with patient-reported outcomes after correcting chronic atlantoaxial instability'. Together they form a unique fingerprint.

Cite this