• Xia-Qing Sheng, Hao Liu, Yang Meng, Bei-Yu Wang, and Chen Ding.
• Department of Orthopedic Surgery, West China Hospital, Sichuan University No, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
• Eur Spine J. 2022 Oct 1; 31 (10): 270427132704-2713.

PurposeThe pathological changes of basilar invagination (BI) and atlantoaxial dislocation (AAD) include vertical and horizontal dislocations. Current surgical techniques have difficulty in accurately controlling the degree of reduction in these two directions and often require preoperative traction, which increases patients' pain, hospital stay, and medical cost. This study aimed to introduce a novel technique for accurately reducing horizontal and vertical dislocation without preoperative traction and report the radiological and clinical outcomes.MethodsFrom 2010 to 2020, patients with BI and AAD underwent posterior two-step distraction and reduction (TSDR) and occipitocervical fixation. Radiological examination was used to evaluate the reduction degree (RD) and compression. Japanese Orthopedic Association (JOA) score was used to evaluate clinical outcome.ResultsA total of 55 patients with BI and AAD underwent TSDR and occipitocervical fusion. The clinical symptoms of 98.2% of them improved. JOA score increased significantly after the operation. Appropriate (50% ≤ RD < 80%) or satisfactory (RD ≥ 80%) horizontal reduction was achieved in 92.7% of patients, and 90.9% obtained appropriate or satisfactory vertical reduction. Thirty-one patients did not undergo preoperative skull traction. There was no significant difference in radiological outcomes or JOA scores between the traction and non-traction groups. However, the length of hospital stay in the traction group was longer than that in the non-traction group.ConclusionTSDR enables horizontal and vertical reduction. It is a safe, simple, and effective technique for patients with BI and AAD. Despite the absence of preoperative skull traction, the degree of reduction and clinical outcomes were satisfactory.© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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