Intraarticular structural bone grafting maintains column height in atlantoaxial facet joints

Jun Zhu and colleagues from the Division of Spine Surgery, Department of Orthopedics, Daping Hospital of Army Medical University, China investigated the necessity of nonstructural or structural intraarticular bone grafting in atlantoaxial facet joints via a posterior approach and the influence by the presence of basilar invagination (BI).

The authors reviewed patients who underwent posterior atlantoaxial or occipitocervical arthrodesis surgery at one institute. Operation records, preoperative and postoperative clinical status, and radiological films were analyzed.

Thirty-three patients (19 without BI, 14 with BI) underwent posterior facet joint release followed by intraarticular bone grafting were enrolled finally. Twenty-four nonstructural (15 without BI, 9 with BI) and 9 structural (4 without BI, 5 with BI) grafting were performed. The average follow-up was 32.15±6.73 months (24–47 months).

Among them, 1 (3.03%) implant failure occurred, and 32 (96.97%) achieved satisfactory neurological outcomes, including 28 (84.85%) complete and 4 (12.12%) acceptable reductions with complete fusion within 6 months.

For patients without basilar invagination, structural and nonstructural grafting showed no significant difference in terms of reduction maintenance (100% vs 73.33%, p = 0.530), while for those with basilar invagination, structural grafting significantly increased the postoperative height of the joint space (5.67±1.22 mm vs 3.43±1.78 mm, p = 0.002) and maintained it much better than nonstructural grafting (88.89% vs 20.00%, p = 0.023), contributing notably to basilar invagination correction.

Therefore, it was concluded that intraarticular structural bone grafting in atlantoaxial facet joints has the advantage of maintaining anterior column height in the case of lateral mass collapse or when basilar invagination correction is needed; otherwise, nonstructural bone grafting is enough.

Zhu, J., Wu, J., Luo, K. et al. Intraarticular bone grafting in atlantoaxial facet joints via a posterior approach: nonstructural or structural—a minimum 24-month follow-up. J Orthop Surg Res 16, 524 (2021). https://doi.org/10.1186/s13018-021-02630-z